Healthcare Provider Details

I. General information

NPI: 1376589440
Provider Name (Legal Business Name): GREGG BYRON MEEHAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 COURT ST
KEENE NH
03431-1799
US

IV. Provider business mailing address

650 COURT ST
KEENE NH
03431-1799
US

V. Phone/Fax

Practice location:
  • Phone: 603-352-3839
  • Fax:
Mailing address:
  • Phone: 603-352-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1590
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: