Healthcare Provider Details

I. General information

NPI: 1619460466
Provider Name (Legal Business Name): JAYME BETH MEYER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11737 S PRESTON HWY
LEBANON JUNCTION KY
40150-8420
US

IV. Provider business mailing address

2600 WOODSDALE AVE
LOUISVILLE KY
40220-3616
US

V. Phone/Fax

Practice location:
  • Phone: 502-833-4664
  • Fax:
Mailing address:
  • Phone: 502-644-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10105
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: