Healthcare Provider Details

I. General information

NPI: 1033205141
Provider Name (Legal Business Name): CHRISTIAN JOSEF MEYER D.M.D., D.M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 LEXINGTON ST SUITE 202
WOBURN MA
01801-5984
US

IV. Provider business mailing address

237 LEXINGTON ST SUITE 202
WOBURN MA
01801-5984
US

V. Phone/Fax

Practice location:
  • Phone: 781-775-1147
  • Fax:
Mailing address:
  • Phone: 781-775-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18534
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: