Provider Demographics
NPI:1972345734
Name:EMILY MELLION DDS PEDIATRIC DENTISTRY INC
Entity type:Organization
Organization Name:EMILY MELLION DDS PEDIATRIC DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MELLION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-483-5792
Mailing Address - Street 1:3591 RESERVE COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5334
Mailing Address - Country:US
Mailing Address - Phone:330-723-7566
Mailing Address - Fax:
Practice Address - Street 1:3591 RESERVE COMMONS DR STE 200
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5334
Practice Address - Country:US
Practice Address - Phone:330-723-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental