Provider Demographics
NPI:1780601765
Name:MELEKHIN, ALEKSANDR V (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEKSANDR
Middle Name:V
Last Name:MELEKHIN
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 1:2471 NAPFLE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3855
Mailing Address - Country:US
Mailing Address - Phone:215-332-6666
Mailing Address - Fax:
Practice Address - Street 1:2471 NAPFLE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3855
Practice Address - Country:US
Practice Address - Phone:215-332-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028941-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014757410004Medicaid