Provider Demographics
NPI:1518588920
Name:POOPPALLIL, MELINA CHERIAN (DDS)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:CHERIAN
Last Name:POOPPALLIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:NAYYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:13 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6136
Mailing Address - Country:US
Mailing Address - Phone:914-552-6356
Mailing Address - Fax:
Practice Address - Street 1:381 S LITTLE TOR RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1427
Practice Address - Country:US
Practice Address - Phone:845-634-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY618911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program