NPIMap

Organization Active NPI

Kim R. Melton, DDS, PHD, P.a.

  • Dentist
  • Wake Forest, NC
National Provider Identifier
1679788202
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7307 Issued in NC
Legal business name
KIM R. MELTON, DDS, PHD, P.A.
Practice address
3205 Rogers Rd
Wake Forest, NC 27587-3805
Phone
(909) 453-2300
Fax
(919) 453-2301
NPI assigned
May 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kim R Melton, DDS, PHDNPI 1295940815
Title
President
Phone
(919) 453-2300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7307 NC Primary

Addresses

Primary practice location

3205 Rogers Rd
Wake Forest, NC 27587-3805

Mailing address

3205 Rogers Rd
Wake Forest, NC 27587-3805
Phone (909) 453-2300

Other identifiers 1

IdentifierTypeStateIssuer
8990174MedicaidNC

Other names 1

  • Heritage Aesthetic Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679788202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 ROGERS RD",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873805",
            "telephone_number": "909-453-2300",
            "fax_number": "919-453-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 ROGERS RD",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873805",
            "telephone_number": "909-453-2300",
            "fax_number": "919-453-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM R. MELTON, DDS, PHD, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-453-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, PHD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "7307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8990174",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Aesthetic Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wake Forest, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.