Healthcare Provider Details

I. General information

NPI: 1568375277
Provider Name (Legal Business Name): INDIALANTIC DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 4TH AVE
INDIALANTIC FL
32903-4213
US

IV. Provider business mailing address

329 4TH AVE
INDIALANTIC FL
32903-4213
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-5242
  • Fax: 321-676-3230
Mailing address:
  • Phone: 321-723-5242
  • Fax: 321-676-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MEAGAN F THOMAS
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 321-723-5242