Provider Demographics
NPI:1639388812
Name:ADDICKS, EARL MELVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:MELVIN
Last Name:ADDICKS
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 1:207 SINGLETREE CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6526
Mailing Address - Country:US
Mailing Address - Phone:410-526-4750
Mailing Address - Fax:410-526-4786
Practice Address - Street 1:2025 SUFFOLK RD
Practice Address - Street 2:SUITE 12
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-1633
Practice Address - Country:US
Practice Address - Phone:410-526-4750
Practice Address - Fax:410-526-4786
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist