Provider Demographics
NPI:1962973347
Name:PETE N MELLAS DMD MS PLLC
Entity type:Organization
Organization Name:PETE N MELLAS DMD MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-404-4458
Mailing Address - Street 1:4910 E GREENWAY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1653
Mailing Address - Country:US
Mailing Address - Phone:602-404-4458
Mailing Address - Fax:
Practice Address - Street 1:4910 E GREENWAY RD STE 2
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1653
Practice Address - Country:US
Practice Address - Phone:602-404-4458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1316947963OtherNPI TYPE 1