Provider Demographics
NPI:1548360548
Name:MELTON, GINGER H (RDH)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:H
Last Name:MELTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4818
Mailing Address - Country:US
Mailing Address - Phone:757-399-4588
Mailing Address - Fax:757-399-5076
Practice Address - Street 1:664 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4818
Practice Address - Country:US
Practice Address - Phone:757-399-4588
Practice Address - Fax:757-399-5076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402003394124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist