Provider Demographics
NPI:1881821452
Name:STELLAR DENTAL CARE
Entity Type:Organization
Organization Name:STELLAR DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-632-5555
Mailing Address - Street 1:7500 TRANSIT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6018
Mailing Address - Country:US
Mailing Address - Phone:716-632-5555
Mailing Address - Fax:716-632-9824
Practice Address - Street 1:7500 TRANSIT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6018
Practice Address - Country:US
Practice Address - Phone:716-632-5555
Practice Address - Fax:716-632-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03098051Medicaid