Provider Demographics
NPI:1336371988
Name:MELANSON, MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MELANSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5980
Mailing Address - Country:US
Mailing Address - Phone:770-916-5362
Mailing Address - Fax:678-247-7829
Practice Address - Street 1:1923 MARSHA SHARP FWY
Practice Address - Street 2:103
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-4036
Practice Address - Country:US
Practice Address - Phone:806-744-6581
Practice Address - Fax:806-747-9794
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248991223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice