Active NPI
Melonie Rachel Dutton, D.D.S. (PEDIATRICS)
- Pediatric Dentistry
- Texas City, TX
National Provider Identifier
1508986183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 17982
- Practice address
- 1114 14TH St N
Texas City, TX 77590-5413 - Phone
- (409) 945-8080
- Fax
- (409) 945-4325
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 17982 | TX | Primary |
Addresses
Primary practice location
1114 14TH St N
Texas City, TX 77590-5413
Mailing address
1114 14TH St N
Texas City, TX 77590-5413
Phone (409) 945-8080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G60405-01 | Other | TX | CHIPS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17982 | TX | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Texas Children'S Dental Universe | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Texas City, TX
- NPI 1285811364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508986183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1114 14TH ST N",
"city": "TEXAS CITY",
"state": "TX",
"postal_code": "775905413",
"telephone_number": "409-945-8080",
"fax_number": "409-945-4325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 14TH ST N",
"city": "TEXAS CITY",
"state": "TX",
"postal_code": "775905413",
"telephone_number": "409-945-8080",
"fax_number": "409-945-4325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTTON",
"first_name": "MELONIE",
"middle_name": "RACHEL",
"name_prefix": "Dr.",
"credential": "D.D.S. (PEDIATRICS)",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "17982",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIPS",
"identifier": "G60405-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Texas City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.