Provider Demographics
NPI:1982689519
Name:MELBOURNE, KENT (DDS)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:MELBOURNE
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 1:8305 KIVA DUNES LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4682
Mailing Address - Country:US
Mailing Address - Phone:865-377-3100
Mailing Address - Fax:
Practice Address - Street 1:2606 GREENWAY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1904
Practice Address - Country:US
Practice Address - Phone:865-688-7699
Practice Address - Fax:865-688-7695
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000073901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice