Provider Demographics
NPI:1104197060
Name:MELTON, SCOTT TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:TIMOTHY
Last Name:MELTON
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 1:6000 N OAK TRFY STE 304
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5176
Mailing Address - Country:US
Mailing Address - Phone:816-455-6300
Mailing Address - Fax:816-455-4072
Practice Address - Street 1:6000 N OAK TRFY STE 304
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5176
Practice Address - Country:US
Practice Address - Phone:816-455-6300
Practice Address - Fax:816-455-4072
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0160731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice