Provider Demographics
NPI:1316326903
Name:MELVIN, HOWARD DARYL II
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:DARYL
Last Name:MELVIN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 15TH ST STE 520
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-6566
Mailing Address - Country:US
Mailing Address - Phone:817-529-8151
Mailing Address - Fax:
Practice Address - Street 1:100 E 15TH ST STE 520
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6566
Practice Address - Country:US
Practice Address - Phone:817-529-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325941223P0221X, 1223G0001X
OH30.0274291223P0221X
MD15839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice