Healthcare Provider Details

I. General information

NPI: 1346777448
Provider Name (Legal Business Name): ARCHIBALD LOUIS MELCHER IV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40470 GERMANY RD
GONZALES LA
70737-6735
US

IV. Provider business mailing address

4909 DREYFOUS AVE
METAIRIE LA
70006-1222
US

V. Phone/Fax

Practice location:
  • Phone: 504-756-0940
  • Fax:
Mailing address:
  • Phone: 504-756-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6748
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: