Provider Demographics
NPI:1972689297
Name:MELVYN E. NATHANSON, DDS, PA
Entity Type:Organization
Organization Name:MELVYN E. NATHANSON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NATHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-733-9662
Mailing Address - Street 1:11484 OHANU CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7031
Mailing Address - Country:US
Mailing Address - Phone:561-733-9662
Mailing Address - Fax:
Practice Address - Street 1:11484 OHANU CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-7031
Practice Address - Country:US
Practice Address - Phone:561-733-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0082341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSOCIAL SECURITY NUMBER