Healthcare Provider Details

I. General information

NPI: 1396797627
Provider Name (Legal Business Name): JOHN THOMAS MEADOWS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 OFFICE PARK DR
JACKSONVILLE NC
28546-3217
US

IV. Provider business mailing address

46 OFFICE PARK DR
JACKSONVILLE NC
28546-3217
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-3535
  • Fax:
Mailing address:
  • Phone: 910-353-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number3953
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: