Provider Demographics
NPI:1306167333
Name:MELONAKOS, STEVEN JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:MELONAKOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PLANTATION RIDGE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9238
Mailing Address - Country:US
Mailing Address - Phone:704-660-5800
Mailing Address - Fax:704-660-5801
Practice Address - Street 1:130 PLANTATION RIDGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9238
Practice Address - Country:US
Practice Address - Phone:704-660-5800
Practice Address - Fax:704-660-5801
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915795Medicaid