Healthcare Provider Details

I. General information

NPI: 1083875975
Provider Name (Legal Business Name): MELANI HELENE KAPETANAKOS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 COOPER CREEK BLVD UNIT 115
UNIVERSITY PARK FL
34201-2028
US

IV. Provider business mailing address

5580 46TH CT W
BRADENTON FL
34210-6602
US

V. Phone/Fax

Practice location:
  • Phone: 212-319-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number051581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: