Healthcare Provider Details

I. General information

NPI: 1457361511
Provider Name (Legal Business Name): MELISSA OLIVO HELLER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 TROY HILLS RD
WHIPPANY NJ
07981-1501
US

IV. Provider business mailing address

69 BIRCH PKWY
SPARTA NJ
07871-1225
US

V. Phone/Fax

Practice location:
  • Phone: 973-386-0300
  • Fax:
Mailing address:
  • Phone: 973-518-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02266900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050431-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037160
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: