MEDICARE: DR. DALIA E MEISHA

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	122300000X	Dentist	10087	MA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401413430	VA

General Provider Information

NPI Number	:	1619124732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALIA E MEISHA

Provider Business Mailing Address
First Line	:	1502 WILLIAMSON RD NE
Second Line	:	SUITE 1000
City	:	ROANOKE
State	:	VA
Zip	:	24012-5130
Country	:	US
Telephone Number	:	540-206-2203
Fax Number	:	540-400-0525

Provider Business Practice Location Address
First Line	:	201 W 8TH ST
Second Line	:	SUITE 810
City	:	PUEBLO
State	:	CO
Zip	:	81003-3038
Country	:	US
Telephone Number	:	719-562-4447
Fax Number	:

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

Provider Enumeration Date	:	08/20/2008
Last Update Date	:	01/11/2012

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