Healthcare Provider Details

I. General information

NPI: 1073995585
Provider Name (Legal Business Name): KYLE MEEK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E WASHINGTON ST
CLARINDA IA
51632-1611
US

IV. Provider business mailing address

104 E WASHINGTON ST
CLARINDA IA
51632-1611
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-5196
  • Fax:
Mailing address:
  • Phone: 712-542-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7245
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: