Provider Demographics
NPI:1821232760
Name:MELK, JONATHON J (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:J
Last Name:MELK
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 1:540 VILLAGE WALK LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9554
Mailing Address - Country:US
Mailing Address - Phone:920-699-2554
Mailing Address - Fax:920-699-3059
Practice Address - Street 1:540 VILLAGE WALK LN
Practice Address - Street 2:SUITE E
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9554
Practice Address - Country:US
Practice Address - Phone:920-699-2554
Practice Address - Fax:920-699-3059
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5982-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225124571OtherNPI