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Organization
JOE MEDELLIN DDS, INC.
Active
Organization
JOE MEDELLIN DDS, INC.
Active
Other names
OrthoGrace Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOE MEDELLIN DDS (OWNER)
(818) 280-5596
Entity
Organization
Contact information
Practice address
8949 RESEDA BLVD STE 116, NORTHRIDGE, CA 91324-3995
(818) 280-5596
(818) 975-5596
Mailing address
8949 RESEDA BLVD STE 116, NORTHRIDGE, CA 91324-3995
(818) 280-5596
(818) 975-5596
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/13/2018
Last updated
11/13/2018
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