| Organization Name: | MELANCON FAMILY DENTISTRY LLC |
| NPI Number: | 1063759736 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW JOHN MELANCON (OWNER/DENTIST) |
| Mailing Address: | 300 W Madison St Broussard |
| State: | LA US |
| Postal Code: | 705184518 |
| Phone Number: | 3378371861 |
| Fax Number: | 3378371278 |
| NPI Enumeration Date: | 01/14/2013 |
| NPI Last Update Date: | 01/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 5974 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |