Healthcare Provider Details

I. General information

NPI: 1497851968
Provider Name (Legal Business Name): DAVID MATTHEW MELROD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 M ST NW SUITE 404
WASHINGTON DC
20037-1445
US

IV. Provider business mailing address

2311 M ST NW SUITE 404
WASHINGTON DC
20037-1445
US

V. Phone/Fax

Practice location:
  • Phone: 202-659-5986
  • Fax: 202-296-7169
Mailing address:
  • Phone: 202-659-5986
  • Fax: 202-296-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4156
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: