Provider Demographics
NPI:1225125636
Name:MELVIN, JAY R (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:R
Last Name:MELVIN
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 1:2 MERIDIAN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-376-8297
Mailing Address - Fax:610-372-8080
Practice Address - Street 1:2 MERIDIAN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3202
Practice Address - Country:US
Practice Address - Phone:610-376-8297
Practice Address - Fax:610-372-8080
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-18459-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics