Healthcare Provider Details

I. General information

NPI: 1245304427
Provider Name (Legal Business Name): NICHOLAS PETER MELLION DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 EDISON ST NW
UNIONTOWN OH
44685-8428
US

IV. Provider business mailing address

3451 EDISON ST NW
UNIONTOWN OH
44685-8428
US

V. Phone/Fax

Practice location:
  • Phone: 330-699-6369
  • Fax: 330-699-6369
Mailing address:
  • Phone: 330-699-6369
  • Fax: 330-699-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30015784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: