MEDICARE: DR. BRENT ALLEN MEINHARDT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	26206	CA

General Provider Information

NPI Number	:	1518161942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT ALLEN MEINHARDT D.D.S.

Provider Business Mailing Address
First Line	:	9700 RESEDA BLVD
Second Line	:	SUITE #102
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-2025
Country	:	US
Telephone Number	:	818-993-0846
Fax Number	:	808-993-7998

Provider Business Practice Location Address
First Line	:	9700 RESEDA BLVD
Second Line	:	SUITE #102
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-2025
Country	:	US
Telephone Number	:	818-993-0846
Fax Number	:	808-993-7998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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