Basic Information
| Provider Information | |||||||||
| NPI: | 1760832471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELTON | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | US ARMY DENTAL ACTIVITY BLDG 128 CHAFFEE ROAD | ||||||||
| Address2: | ATTN: DENTAC HEADQUARETERS | ||||||||
| City: | FT BLISS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157426001 | ||||||||
| FaxNumber: | 9157427462 | ||||||||
| Practice Location | |||||||||
| Address1: | US ARMY DENTAL ACTIVITY BLDG 128 CHAFFEE ROAD | ||||||||
| Address2: | ATTN: DENTAC HEADQUARETERS | ||||||||
| City: | FT BLISS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157426001 | ||||||||
| FaxNumber: | 9157427462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2016 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 124Q00000X | TX | Y | Dental Providers | Dental Hygienist |
No ID Information.