MEDICARE: MELVIN L FORD III D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401-006024	VA

General Provider Information

NPI Number	:	1447231337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN L FORD III D.D.S.

Provider Business Mailing Address
First Line	:	2875 SABRE STREET
Second Line	:	SUITE 260
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452
Country	:	US
Telephone Number	:	757-499-6886
Fax Number	:	757-499-3464

Provider Business Practice Location Address
First Line	:	2875 SABRE STREET
Second Line	:	SUITE 260
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452
Country	:	US
Telephone Number	:	757-499-6886
Fax Number	:	757-499-3464

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	06/14/2016

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