Basic Information
| Provider Information | |||||||||
| NPI: | 1477031888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELHAUSER | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | COWAN DENTAL CLINIC | ||||||||
| Address2: | 605 RANDOLPH ROAD | ||||||||
| City: | FORT SILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804425925 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | COWAN DENTAL CLINIC | ||||||||
| Address2: | 605 RANDOLPH RD | ||||||||
| City: | FORT SILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735034535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804425925 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2018 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN.00203688 | CO | Y | Dental Providers | Dentist |
No ID Information.