Provider Demographics
NPI:1386065688
Name:MELLION, THERESA (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:MELLION
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 WALES AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-1841
Mailing Address - Country:US
Mailing Address - Phone:330-833-3335
Mailing Address - Fax:330-833-5404
Practice Address - Street 1:3235 WALES AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-1841
Practice Address - Country:US
Practice Address - Phone:330-833-3335
Practice Address - Fax:330-833-5404
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13860656881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics