Healthcare Provider Details

I. General information

NPI: 1861323438
Provider Name (Legal Business Name): CAMERON MICHAEL MELANCON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N CANAL BLVD
THIBODAUX LA
70301-8076
US

IV. Provider business mailing address

113 ORCHARD DR
THIBODAUX LA
70301-9417
US

V. Phone/Fax

Practice location:
  • Phone: 985-441-8340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7797
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: