Provider Demographics
NPI:1154402436
Name:MATTHES, MELINDA MAE (DDS)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MAE
Last Name:MATTHES
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 1:505 E PALM VALLEY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3041
Mailing Address - Country:US
Mailing Address - Phone:512-255-6197
Mailing Address - Fax:512-255-3850
Practice Address - Street 1:505 E PALM VALLEY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3041
Practice Address - Country:US
Practice Address - Phone:512-255-6197
Practice Address - Fax:512-255-3850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist