Provider Demographics
NPI:1619950441
Name:MELLA, PAULA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:M
Last Name:MELLA
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 1:103 SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-6203
Mailing Address - Country:US
Mailing Address - Phone:212-304-4832
Mailing Address - Fax:121-230-4488
Practice Address - Street 1:207 DYCKMAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1064
Practice Address - Country:US
Practice Address - Phone:212-304-4832
Practice Address - Fax:212-304-4880
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01154127Medicaid