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Deactivated NPI 1063505162 Deactivated / Inactive NPI Male Practitioner

Dr. Jack Heyward Melton , DMD

Dentist - General Practice • St Simons Island, GA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jack Melton has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 02, 2006
NPI Deactivation Date July 08, 2021
Total Practice Duration ~15 Years of Practice (2006 – 2021)

Professional Overview & Biography Verified Profile Summary

Dr. Jack Melton, DMD was a registered Dentist - General Practice practicing in St Simons Island, GA. Throughout an active medical career spanning 15 years, Dr. Melton provided care at the practice location at 300 MAIN ST until profile deactivation on 2021-07-08.

Practice Location & Contact Primary Location

Practice Address

300 Main St
Ste 101

St Simons Island, GA 315221666

Telephone 9126389001
Fax 9126349819
Associated Practice Facility / Clinic
🏢 Plantation Dental Associates Facility NPI 1063505113

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in St Simons Island, GA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 22.8 Yrs
Regional Practice Density
7 Specialists

Practicing in St Simons Island, GA (3302 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License GA DN008285

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1811330301

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 08, 2021

Record deactivated on July 08, 2021

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 300 MAIN ST, STE 101, ST SIMONS ISLAND, GA 315221666 (Tel: 9126389001)

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Updated Business Mailing Address July 08, 2007

Registered at 300 MAIN ST, STE 101, ST SIMONS ISLAND, GA 315221666 (Tel: 9126389001)

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Provider Name / Credentials Updated July 08, 2007

Recorded as JACK MELTON, DMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #DN008285 in GA)

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Initial NPI Registration & Enumeration October 02, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1063505162
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 02, 2006
Last Update: July 08, 2007
Deactivation Date: July 08, 2021

Mailing Address

300 Main St, Ste 101

St Simons Island, GA 315221666

Phone: 9126389001

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.