Provider Demographics
NPI:1508986183
Name:DUTTON, MELONIE RACHEL (DDS (PEDIATRICS))
Entity Type:Individual
Prefix:DR
First Name:MELONIE
Middle Name:RACHEL
Last Name:DUTTON
Suffix:
Gender:F
Credentials:DDS (PEDIATRICS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 14TH ST N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-5413
Mailing Address - Country:US
Mailing Address - Phone:409-945-8080
Mailing Address - Fax:409-945-4325
Practice Address - Street 1:1114 14TH ST N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-5413
Practice Address - Country:US
Practice Address - Phone:409-945-8080
Practice Address - Fax:409-945-4325
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60405-01OtherCHIPS