Dr. Nathaniel Simon Mellul, DMD
Student in an Organized Health Care Education/Training Program in Phoenix, AZ. Individual provider (NPI-1).
NPI number1043006554
StatusActive
Last updated in NPPESMay 6, 2025
Details
- NPI
- 1043006554
- Entity type
- Individual (NPI-1)
- Name
- Dr. Nathaniel Simon Mellul
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 19, 2025
- Certification date
- May 6, 2025
- Last updated
- May 6, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
420 W Watkins StPhoenix, AZ 85003-2830
Phone 602-261-6842
Mailing address
22 Exton CirCherry Hill, NJ 08003-2961
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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