Healthcare Provider Details

I. General information

NPI: 1184613820
Provider Name (Legal Business Name): MELANIE JANE FATONE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 W MAIN ST
NORWICH CT
06360-5316
US

IV. Provider business mailing address

110 BUCKLEY RD
SALEM CT
06420-3742
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-5576
  • Fax:
Mailing address:
  • Phone: 860-889-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8112
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: