Provider Demographics
NPI:1851305924
Name:MELNICK, MARC L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:MELNICK
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 1:938 HUDSON ST
Mailing Address - Street 2:P.O. BOX 3279
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5149
Mailing Address - Country:US
Mailing Address - Phone:201-659-0750
Mailing Address - Fax:201-659-0757
Practice Address - Street 1:938 HUDSON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5149
Practice Address - Country:US
Practice Address - Phone:201-659-0750
Practice Address - Fax:201-659-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ118771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice