Provider Demographics
NPI:1639189145
Name:GARVIN, MELFORD CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELFORD
Middle Name:CARL
Last Name:GARVIN
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 1:1420 84TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9344
Mailing Address - Country:US
Mailing Address - Phone:616-878-1514
Mailing Address - Fax:616-878-1463
Practice Address - Street 1:1420 84TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9344
Practice Address - Country:US
Practice Address - Phone:616-878-1514
Practice Address - Fax:616-878-1463
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI100721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice