Provider Demographics
NPI:1194929802
Name:MCKELVAIN, GARLAND DUDLEY (DDS,MSD,INC)
Entity type:Individual
Prefix:DR
First Name:GARLAND
Middle Name:DUDLEY
Last Name:MCKELVAIN
Suffix:
Gender:M
Credentials:DDS,MSD,INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-5601
Mailing Address - Country:US
Mailing Address - Phone:817-572-4949
Mailing Address - Fax:817-478-7750
Practice Address - Street 1:4224 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-5601
Practice Address - Country:US
Practice Address - Phone:817-572-4949
Practice Address - Fax:817-478-7750
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics