Provider Demographics
NPI:1447231337
Name:FORD, MELVIN L III (DDS)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:L
Last Name:FORD
Suffix:III
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 1:2875 SABRE STREET
Mailing Address - Street 2:SUITE 260
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-499-6886
Mailing Address - Fax:757-499-3464
Practice Address - Street 1:2875 SABRE STREET
Practice Address - Street 2:SUITE 260
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-499-6886
Practice Address - Fax:757-499-3464
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0060241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU69118Medicare UPIN
VA19000092VMedicare ID - Type Unspecified