MEDICARE: DR. MELANIE MCPHERSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	40972	TX
2	122300000X	Dentist	22DI02991500	NJ

General Provider Information

NPI Number	:	1063296457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE MCPHERSON DDS

Provider Business Mailing Address
First Line	:	5540 SYCAMORE SCHOOL RD STE 324
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3060
Country	:	US
Telephone Number	:	817-554-4401
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 SYCAMORE SCHOOL RD STE 324
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3060
Country	:	US
Telephone Number	:	817-554-4401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	05/07/2026

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