Provider Demographics
NPI:1326206814
Name:MELTON, JOHN JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JEFFREY
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 1:141 PASEO DE PERALTA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2914
Mailing Address - Country:US
Mailing Address - Phone:505-984-8300
Mailing Address - Fax:505-986-8005
Practice Address - Street 1:141 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2914
Practice Address - Country:US
Practice Address - Phone:505-984-8300
Practice Address - Fax:505-986-8005
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD24721223P0300X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics