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General NPI Number Information
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NPI Number | 1386065688
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Entity Type | Individual
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Provider Name | THERESA MELLION DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 3235 WALES AVE NW
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City | MASSILLON
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State | OH
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Zip | 44646-1841
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Country | US
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Telephone | 330-833-3335
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Fax | 330-833-5404
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Provider Business Mailing Address
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Address Line | 3235 WALES AVE NW
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City | MASSILLON
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State | OH
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Zip | 44646-1841
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Country | US
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Telephone | 330-833-3335
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Fax | 330-833-5404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1386065688
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License Number State | OH
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