Healthcare Provider Details

I. General information

NPI: 1225214570
Provider Name (Legal Business Name): ELIZABETH ANN MEADE D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 PACKARD RD
YPSILANTI MI
48197-1851
US

IV. Provider business mailing address

1900 PACKARD RD
YPSILANTI MI
48197-1851
US

V. Phone/Fax

Practice location:
  • Phone: 734-481-1060
  • Fax:
Mailing address:
  • Phone: 734-481-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018846
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: