Healthcare Provider Details

I. General information

NPI: 1639348659
Provider Name (Legal Business Name): RAYMOND MICHAEL MEYER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2008
Last Update Date: 02/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 COLBY ST
BERKELEY CA
94705-2092
US

IV. Provider business mailing address

106 PLAZA DR
BERKELEY CA
94705-2416
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-2434
  • Fax:
Mailing address:
  • Phone: 510-655-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: