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General NPI Number Information
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NPI Number | 1275367765
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Entity Type | Organization
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Legal Business Name | YOUR SYRACUSE FAMILY DENTIST P.C.
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 4627 ONONDAGA BLVD
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City | SYRACUSE
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State | NY
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Zip | 13219-3301
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Country | US
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Telephone | 315-477-9960
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Fax |
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Provider Business Mailing Address
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Address Line | 4627 ONONDAGA BLVD
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City | SYRACUSE
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State | NY
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Zip | 13219-3301
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Country | US
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Telephone | 315-477-9960
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Fax |
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Authorized Official
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Title or Position | PARTNER/DENTIST
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Name | DR. JOSEPH MELUNI
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Credential | DDS
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Telephone | 315-477-9960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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