Provider Demographics
NPI:1477031888
Name:MELHAUSER, PRESTON MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:MICHAEL
Last Name:MELHAUSER
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:COWAN DENTAL CLINIC
Mailing Address - Street 2:605 RANDOLPH ROAD
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-442-5925
Mailing Address - Fax:
Practice Address - Street 1:COWAN DENTAL CLINIC
Practice Address - Street 2:605 RANDOLPH RD
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4535
Practice Address - Country:US
Practice Address - Phone:580-442-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist