Healthcare Provider Details

I. General information

NPI: 1407020548
Provider Name (Legal Business Name): MEADE FAMILY DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2008
Last Update Date: 04/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 COMMERCE DR
ALLENDALE MI
49401-8200
US

IV. Provider business mailing address

11301 COMMERCE DR
ALLENDALE MI
49401-8200
US

V. Phone/Fax

Practice location:
  • Phone: 616-895-7199
  • Fax: 616-895-5698
Mailing address:
  • Phone: 616-895-7199
  • Fax: 616-895-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901013664
License Number StateMI

VIII. Authorized Official

Name: DR. JERE BOOTH MEADE
Title or Position: TREASURER
Credential: D.D.S.
Phone: 616-895-7199