Healthcare Provider Details

I. General information

NPI: 1821078155
Provider Name (Legal Business Name): MELVIN SYLVESTER POLK JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 NOLENSVILLE PIKE
NASHVILLE TN
37211-5408
US

IV. Provider business mailing address

9636 MITCHELL PL
BRENTWOOD TN
37027-8482
US

V. Phone/Fax

Practice location:
  • Phone: 615-333-2833
  • Fax: 615-333-2863
Mailing address:
  • Phone: 615-776-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS3729
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: