Individual
JONATHAN MELBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11065 PACIFIC CREST PL NW STE B105, SILVERDALE, WA 98383-6607
(360) 261-6154
Mailing address
2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD, COMMANDING OFFICER, CAMP LEJEUNE, NC 28542-0130
(910) 451-2208
(910) 451-8036
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012430A
IN
1223G0001X
General Practice Dentistry
DE60813142
WA
Other
Enumeration date
11/13/2015
Last updated
03/29/2019
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