Provider Demographics
NPI:1770193625
Name:MELLUSI, SABRINA (DDS)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:MELLUSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2530
Mailing Address - Country:US
Mailing Address - Phone:908-879-2634
Mailing Address - Fax:
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2530
Practice Address - Country:US
Practice Address - Phone:908-879-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123031122300000X
NJ22DI03073800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist