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NPI Code Detail

MEDICARE: DR. MICHAEL EUGENE MELLAND RN BSN DDS

MEDICARE: DR. MICHAEL EUGENE MELLAND RN BSN 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
11223G0001XGeneral Practice Dentistry7197KS
2122300000XDentistDEN-DEN-LIC-25965MT

General Provider Information

NPI Number : 1467588988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL EUGENE MELLAND RN BSN DDS
Provider Business Mailing Address
First Line : 717 3RD ST
Second Line :
City : HAVRE
State : MT
Zip : 59501-3721
Country : US
Telephone Number : 701-421-1463
Fax Number :
Provider Business Practice Location Address
First Line : 6850 UPPER BOX ELDER RD
Second Line :
City : BOX ELDER
State : MT
Zip : 59521-9073
Country : US
Telephone Number : 406-395-4486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 09/12/2023

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