Provider Demographics
NPI:1467684910
Name:HONRADO, MELISSA B (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:HONRADO
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 1:673 9TH AVE
Mailing Address - Street 2:APT 2S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3621
Mailing Address - Country:US
Mailing Address - Phone:646-584-1654
Mailing Address - Fax:
Practice Address - Street 1:470 PENDALE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4055
Practice Address - Country:US
Practice Address - Phone:718-351-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054359-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice