Provider Demographics
NPI:1811095995
Name:MELSON, JAMES ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MELSON
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:MT. PLEASANT CENTER
Mailing Address - Street 2:1400 WEST PICKARD
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-773-7921
Mailing Address - Fax:989-772-5093
Practice Address - Street 1:MT. PLEASANT CENTER
Practice Address - Street 2:1400 WEST PICKARD
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-773-7921
Practice Address - Fax:989-772-5093
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist