Healthcare Provider Details

I. General information

NPI: 1487775375
Provider Name (Legal Business Name): JOHN D MEOLA JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 SECOND AVE STE 500
WALTHAM MA
02451-1114
US

IV. Provider business mailing address

52 SECOND AVE
WALTHAM MA
02451-1127
US

V. Phone/Fax

Practice location:
  • Phone: 781-890-4900
  • Fax: 781-890-6094
Mailing address:
  • Phone: 781-890-4900
  • Fax: 781-890-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: