Provider Demographics
NPI:1467648931
Name:NOVETSKY, MELISSA JILL-FISCHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JILL-FISCHER
Last Name:NOVETSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32669 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1677
Mailing Address - Country:US
Mailing Address - Phone:734-422-4350
Mailing Address - Fax:734-422-7460
Practice Address - Street 1:32669 WARREN RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1677
Practice Address - Country:US
Practice Address - Phone:734-422-4350
Practice Address - Fax:734-422-7460
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019349122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist