Healthcare Provider Details

I. General information

NPI: 1598873564
Provider Name (Legal Business Name): JOHN W MEARA JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5238 W ST JOE HWY SUITE 2
LANSING MI
48917-4085
US

IV. Provider business mailing address

309 WALBRIDGE DR
EAST LANSING MI
48823-2035
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-1000
  • Fax: 517-886-5566
Mailing address:
  • Phone: 517-351-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901008408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: