Provider Demographics
NPI:1508114398
Name:MELVIN, THOMAS ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:MELVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:ANTHONY
Other - Last Name:MELVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3901 S PEARDALE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2823
Mailing Address - Country:US
Mailing Address - Phone:925-284-9523
Mailing Address - Fax:
Practice Address - Street 1:3901 S PEARDALE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-2823
Practice Address - Country:US
Practice Address - Phone:925-284-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD24485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist