Provider Demographics
NPI:1497830772
Name:MELTON, GREGORY MARK (DDS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MARK
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 1:1132 MIDTOWN DRIVE
Mailing Address - Street 2:1132 MIDTOWN DRIVE
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-846-7799
Mailing Address - Fax:979-326-1510
Practice Address - Street 1:1132 MIDTOWN DRIVE
Practice Address - Street 2:1132 MIDTOWN DRIVE
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-846-7799
Practice Address - Fax:979-326-1510
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice