Basic Information
| Provider Information | |||||||||
| NPI: | 1871682948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELON | ||||||||
| FirstName: | JESSETTE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 FM 1488 RD | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773843817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362715440 | ||||||||
| FaxNumber: | 7878791769 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 FM 1488 RD | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773843817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362715440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 1223G0001X | 2129 | PR | N | Dental Providers | Dentist | General Practice | 1223G0001X | 27634 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.