Provider Demographics
NPI:1780689281
Name:MCPHAIL, MELVIN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:LEE
Last Name:MCPHAIL
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 1:114 VISION PARK BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3000
Mailing Address - Country:US
Mailing Address - Phone:936-321-1477
Mailing Address - Fax:936-271-1467
Practice Address - Street 1:114 VISION PARK BLVD
Practice Address - Street 2:STE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-3000
Practice Address - Country:US
Practice Address - Phone:936-321-1477
Practice Address - Fax:936-271-1467
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice