Healthcare Provider Details

I. General information

NPI: 1932128519
Provider Name (Legal Business Name): JACK BERNARD MEYER JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

8585 SW 12TH LN
GAINESVILLE FL
32607-7009
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-7450
Mailing address:
  • Phone: 352-332-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17352
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: