Provider Demographics
NPI:1730225301
Name:MELKER, KEVIN BRYAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRYAN
Last Name:MELKER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15237 AMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2155
Mailing Address - Country:US
Mailing Address - Phone:813-978-3636
Mailing Address - Fax:813-972-5430
Practice Address - Street 1:15237 AMBERLY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2155
Practice Address - Country:US
Practice Address - Phone:813-978-3636
Practice Address - Fax:813-972-5430
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics