Provider Demographics
NPI:1275753964
Name:MELLAS, STELLA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:MELLAS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 MARTINSVILLE RD
Mailing Address - Street 2:RIVERWALK VILLAGE CENTER
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-4700
Mailing Address - Country:US
Mailing Address - Phone:908-350-3416
Mailing Address - Fax:908-350-3857
Practice Address - Street 1:665 MARTINSVILLE RD
Practice Address - Street 2:RIVERWALK VILLAGE CENTER
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-4700
Practice Address - Country:US
Practice Address - Phone:908-350-3416
Practice Address - Fax:908-350-3857
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021825031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics