Randi Mellon, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30105 Issued in TX

Practice address

11010 W FM 471 Ste 104
San Antonio, TX 78253-4991

Phone

(210) 688-9386

NPI assigned

Jun 20, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 12, 2016 through May 12, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mellon Dental Management, PLLC

  • General Practice Dentistry
  • Bandera, TX
  • NPI 1336852144
  NPD Authorized official
• Dr Robert E Morgan

  • Pediatric Dentistry
  • Richardson, TX
  • NPI 1730309402
  NPD (past)
• Pioneer Dental, P.a.

  • General Practice Dentistry
  • Arlington, TX
  • NPI 1649368473
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1801200514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3285 BROAD OAK DR",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "780033784",
            "telephone_number": "361-537-2634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 W FM 471 STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782534991",
            "telephone_number": "210-688-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLON",
        "first_name": "RANDI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-20",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1858319",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Simon Mellenbruch
• Amelia M Mellett Keith, DVM
• Rachelle Renee Mellieon, LPC
• Kira S Mello Rogers, PSYD
• Sabina Bernardine Mello, RN
• George Melnik, PHARM.D.
• Estefania Melo, MD
• Jairo A Melo, M.D.
• Sebastian Melo, M.D.
• Melodie K. Wallace, O.D.

• Dentist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.