Healthcare Provider Details

I. General information

NPI: 1386702488
Provider Name (Legal Business Name): MALCOLM MEISTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR 7325
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR 7325
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7325
  • Fax: 954-262-1782
Mailing address:
  • Phone: 954-262-7325
  • Fax: 954-262-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: