Provider Demographics
NPI:1679645915
Name:PERSONS, MELVIN ALAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:ALAN
Last Name:PERSONS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8811 N 51ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4949
Mailing Address - Country:US
Mailing Address - Phone:623-435-0553
Mailing Address - Fax:623-937-1443
Practice Address - Street 1:8811 N 51ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4949
Practice Address - Country:US
Practice Address - Phone:623-435-0553
Practice Address - Fax:623-937-1443
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice