Provider Demographics
NPI:1780836486
Name:MELNYK, TETYANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TETYANA
Middle Name:
Last Name:MELNYK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TETYANA
Other - Middle Name:
Other - Last Name:WOZNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4815 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7825
Mailing Address - Country:US
Mailing Address - Phone:773-728-9200
Mailing Address - Fax:
Practice Address - Street 1:4815 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7825
Practice Address - Country:US
Practice Address - Phone:773-728-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice