MEDICARE: DR. DEBRA A MEADOWS DDS

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	1223E0200X	Endodontics	32790	CA

General Provider Information

NPI Number	:	1902937311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA A MEADOWS DDS

Provider Business Mailing Address
First Line	:	1334 MONTEREY ST
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-6949
Country	:	US
Telephone Number	:	909-798-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015B N WATERMAN AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4834
Country	:	US
Telephone Number	:	909-886-0688
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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