Healthcare Provider Details

I. General information

NPI: 1386830883
Provider Name (Legal Business Name): FREDERICK D. MESLOH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 RIDDELL ST
GREENFIELD MA
01301-2025
US

IV. Provider business mailing address

33 RIDDELL ST
GREENFIELD MA
01301-2025
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-7996
  • Fax: 413-774-7271
Mailing address:
  • Phone: 413-774-7996
  • Fax: 413-774-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13181
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16367
License Number StateMA

VIII. Authorized Official

Name: FREDERICK D MESLOH
Title or Position: OWNER
Credential: DDS
Phone: 413-774-7996