Provider Demographics
NPI:1336602291
Name:DR ARCHIBALD L MELCHER IV LLC
Entity Type:Organization
Organization Name:DR ARCHIBALD L MELCHER IV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHIBALD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MELCHER
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-756-0940
Mailing Address - Street 1:6367 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5033
Mailing Address - Country:US
Mailing Address - Phone:504-737-5294
Mailing Address - Fax:
Practice Address - Street 1:6367 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5033
Practice Address - Country:US
Practice Address - Phone:504-737-5294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental