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General NPI Number Information
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NPI Number | 1124232772
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Entity Type | Organization
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Legal Business Name | W. DAVID MELEVSKY, DDS
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25 LONG CREEK DR
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2440
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Country | US
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Telephone | 207-761-6699
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Fax | 207-761-0245
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Provider Business Mailing Address
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Address Line | 25 LONG CREEK DR
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2440
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Country | US
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Telephone | 207-761-6699
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Fax | 207-761-0245
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. WALTER DAVID MELEVSKY
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Credential | DDS
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Telephone | 207-761-6699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4009
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License Number State | ME
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