Provider Demographics
NPI:1275621203
Name:MELTON, KIRK EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:EUGENE
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 1:3926 BARRON ST STE A200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5797
Mailing Address - Country:US
Mailing Address - Phone:504-456-5103
Mailing Address - Fax:504-456-8471
Practice Address - Street 1:3926 BARRON ST STE A200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5797
Practice Address - Country:US
Practice Address - Phone:504-456-5103
Practice Address - Fax:504-456-8471
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice