Provider Demographics
NPI:1063296457
Name:MCPHERSON, MELANIE (DDS)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PROMENADE PKWY APT 402
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-1365
Mailing Address - Country:US
Mailing Address - Phone:917-446-7411
Mailing Address - Fax:
Practice Address - Street 1:515 PROMENADE PKWY APT 402
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-1365
Practice Address - Country:US
Practice Address - Phone:917-446-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02991500122300000X
TX40972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist