Individual
DR. MARK W MELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10016 E 67TH ST, RAYTOWN, MO 64133-5219
(816) 737-3400
Mailing address
10016 E 67TH ST, RAYTOWN, MO 64133-5219
(816) 737-3400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
013695
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18507068
BLUE CROSS BLUE SHIELD ID
MO
01
—
1B0J4C
DENTE-MAX ID NUMBER
MO
Enumeration date
12/26/2006
Last updated
07/08/2007
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