Provider Demographics
NPI:1932495819
Name:BURRELL, MELVIN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:JAMES
Last Name:BURRELL
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 1:101 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1517
Mailing Address - Country:US
Mailing Address - Phone:434-395-1041
Mailing Address - Fax:434-395-1045
Practice Address - Street 1:101 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1517
Practice Address - Country:US
Practice Address - Phone:434-395-1041
Practice Address - Fax:434-395-1045
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010060251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice