MEDICARE: DR. MEREDITH ALAINE LACEY D.M.D.

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	039495	PA

General Provider Information

NPI Number	:	1598103509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDITH ALAINE LACEY D.M.D.

Provider Business Mailing Address
First Line	:	432 S 9TH ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1812
Country	:	US
Telephone Number	:	570-592-4829
Fax Number	:

Provider Business Practice Location Address
First Line	:	432 S 9TH ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1812
Country	:	US
Telephone Number	:	610-377-5676
Fax Number	:

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	07/01/2019

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