Provider Demographics
NPI:1366464430
Name:MELNICK, SEYMOUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:
Last Name:MELNICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-232-0033
Mailing Address - Fax:860-232-1132
Practice Address - Street 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
Practice Address - Country:US
Practice Address - Phone:860-232-0033
Practice Address - Fax:860-232-1132
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics