Provider Demographics
NPI:1811131709
Name:MELLION, NATHAN DANIEL (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:MELLION
Suffix:
Gender:M
Credentials:DDS, MSD
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics