Provider Demographics
NPI:1598869166
Name:JONES, MELODIE ANDERSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:ANDERSON
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MELODIE
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4130 CARMICHAEL ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-277-5666
Mailing Address - Fax:334-277-9947
Practice Address - Street 1:4130 CARMICHAEL ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-277-5666
Practice Address - Fax:334-277-9947
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51517847OtherBLUE CROSS BLUE SHIELD AL
AL806960OtherUNITED CONCORDIA