Provider Demographics
NPI:1386866127
Name:MELTON, DARLENE CHRISTINE (BA, DDS)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:CHRISTINE
Last Name:MELTON
Suffix:
Gender:F
Credentials:BA, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3171
Mailing Address - Country:US
Mailing Address - Phone:630-655-3636
Mailing Address - Fax:
Practice Address - Street 1:403 WILLIAMSBURG AVE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1091
Practice Address - Country:US
Practice Address - Phone:630-208-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.022916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.022916OtherIL DENTAL LICENSE #
IL021.00160OtherIL DENTAL SPECIALIST #