MEDICARE: MESHKOV-REED DENTAL ASSOCIATES PC

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	DS022657L	PA

General Provider Information

NPI Number	:	1891800413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESHKOV-REED DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	6421 BUSTLETON AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2905
Country	:	US
Telephone Number	:	215-535-0874
Fax Number	:	215-535-3330

Provider Business Practice Location Address
First Line	:	6421 BUSTLETON AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2905
Country	:	US
Telephone Number	:	215-535-0874
Fax Number	:	215-535-3330

Authorized Official
Title or Position	:	DENTIST PRESIDENT
Name	:	DR. MICHAEL CRAIG MESHKOV
Credential	:	DDS
Telephone Number	:	215-535-0874

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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