Individual
LAN MELANIE LA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
400 CARILLON PKWY STE 120, ST PETERSBURG, FL 33716-1290
(727) 299-0728
Mailing address
4080 40TH ST N, ST PETERSBURG, FL 33714-4419
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2019016473
MO
122300000X
Dentist
DN21957
FL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
021002977
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2019016473
MO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN21957
FL
Other
Enumeration date
07/27/2016
Last updated
03/25/2024
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