Provider Demographics
NPI:1619035250
Name:MELFI, GREGG RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:RAYMOND
Last Name:MELFI
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 1:480 ADAMS STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-698-0600
Mailing Address - Fax:617-696-3589
Practice Address - Street 1:480 ADAMS STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-698-0600
Practice Address - Fax:617-696-3589
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20231122300000X
RI2159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist