Provider Demographics
NPI:1295940815
Name:MELTON, KIM RENEE (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:RENEE
Last Name:MELTON
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3805
Mailing Address - Country:US
Mailing Address - Phone:919-453-2300
Mailing Address - Fax:919-453-2301
Practice Address - Street 1:3205 ROGERS RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3805
Practice Address - Country:US
Practice Address - Phone:919-453-2300
Practice Address - Fax:919-453-2301
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist