Healthcare Provider Details

I. General information

NPI: 1285419713
Provider Name (Legal Business Name): MELISSA FELLURE DENTAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

2288 W HIGH ST LOT 18
NEWARK OH
43055-7912
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5200
  • Fax:
Mailing address:
  • Phone: 740-326-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: