Provider Demographics
NPI:1689746513
Name:MELAMED, EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:MELAMED
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 1:4324 LULA ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5222
Mailing Address - Country:US
Mailing Address - Phone:713-349-0640
Mailing Address - Fax:
Practice Address - Street 1:9125 WEST RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-8623
Practice Address - Country:US
Practice Address - Phone:713-937-0050
Practice Address - Fax:832-467-3963
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice