Provider Demographics
NPI:1275367765
Name:YOUR SYRACUSE FAMILY DENTIST P.C.
Entity type:Organization
Organization Name:YOUR SYRACUSE FAMILY DENTIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MELUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-477-9960
Mailing Address - Street 1:4627 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3301
Mailing Address - Country:US
Mailing Address - Phone:315-477-9960
Mailing Address - Fax:
Practice Address - Street 1:4627 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3301
Practice Address - Country:US
Practice Address - Phone:315-477-9960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1235261173OtherCMS ISSUED
NY1871117184OtherCMS ISSUED