Healthcare Provider Details

I. General information

NPI: 1316057151
Provider Name (Legal Business Name): MELVIN SYLVESTER WAYMIRE JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 BRANDT PIKE
HYBER HEIGHTS OH
45424-3240
US

IV. Provider business mailing address

7480 BRANDT PIKE
HUBER HEIGHTS OH
45424-3240
US

V. Phone/Fax

Practice location:
  • Phone: 937-237-7170
  • Fax: 937-237-7135
Mailing address:
  • Phone: 937-237-7170
  • Fax: 937-237-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30016716
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number30016716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: