Provider Demographics
NPI:1821078155
Name:POLK, MELVIN SYLVESTER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:SYLVESTER
Last Name:POLK
Suffix:JR
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 1:9636 MITCHELL PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8482
Mailing Address - Country:US
Mailing Address - Phone:615-776-5708
Mailing Address - Fax:
Practice Address - Street 1:4718 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5408
Practice Address - Country:US
Practice Address - Phone:615-333-2833
Practice Address - Fax:615-333-2863
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS37291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
9178327OtherTENNCARE
TN5440294Medicaid