Healthcare Provider Details

I. General information

NPI: 1316298078
Provider Name (Legal Business Name): IGOR MELNIK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 VESTAL PKWY E
VESTAL NY
13850-2083
US

IV. Provider business mailing address

2549 VESTAL PKWY E
VESTAL NY
13850-2083
US

V. Phone/Fax

Practice location:
  • Phone: 917-755-6258
  • Fax:
Mailing address:
  • Phone: 917-755-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number010771
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number056543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: