Provider Demographics
NPI:1457630139
Name:DUNCAN, MELINDA ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:ELLEN
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5146
Mailing Address - Country:US
Mailing Address - Phone:901-786-4130
Mailing Address - Fax:
Practice Address - Street 1:201 E CENTRAL TEXAS EXPY
Practice Address - Street 2:#500
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1887
Practice Address - Country:US
Practice Address - Phone:254-699-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist