MEDICARE: DR. MELVIN LEE MCPHAIL 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	1223G0001X	General Practice Dentistry	12132	TX

General Provider Information

NPI Number	:	1780689281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN LEE MCPHAIL DDS

Provider Business Mailing Address
First Line	:	114 VISION PARK BLVD
Second Line	:	STE 200
City	:	CONROE
State	:	TX
Zip	:	77384-3000
Country	:	US
Telephone Number	:	936-321-1477
Fax Number	:	936-271-1467

Provider Business Practice Location Address
First Line	:	114 VISION PARK BLVD
Second Line	:	STE 200
City	:	CONROE
State	:	TX
Zip	:	77384-3000
Country	:	US
Telephone Number	:	936-321-1477
Fax Number	:	936-271-1467

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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