Healthcare Provider Details

I. General information

NPI: 1861437055
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL MEYER D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 E MONTCLAIR ST
SPRINGFIELD MO
65807-5076
US

IV. Provider business mailing address

1103 E MONTCLAIR ST
SPRINGFIELD MO
65807-5076
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-8800
  • Fax: 417-887-6265
Mailing address:
  • Phone: 417-887-8800
  • Fax: 417-887-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2000158030
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: