Provider Demographics
NPI:1548303878
Name:MELDE, JOHN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MELDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PANORAMA WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:86324-2823
Mailing Address - Country:US
Mailing Address - Phone:480-220-3032
Mailing Address - Fax:
Practice Address - Street 1:667 E MINGUS AVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3760
Practice Address - Country:US
Practice Address - Phone:928-634-7585
Practice Address - Fax:928-634-7257
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist