Healthcare Provider Details

I. General information

NPI: 1497799373
Provider Name (Legal Business Name): TIM R MEADE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
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 Number2901013483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: