Provider Demographics
NPI:1659950897
Name:STOJ, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:STOJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RUBIN DR
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9681
Mailing Address - Country:US
Mailing Address - Phone:585-554-4400
Mailing Address - Fax:844-683-9216
Practice Address - Street 1:2 RUBIN DR
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9681
Practice Address - Country:US
Practice Address - Phone:585-554-4400
Practice Address - Fax:844-683-9216
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062574122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist