Healthcare Provider Details

I. General information

NPI: 1598816498
Provider Name (Legal Business Name): JODI B MEADVIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W COLLINGS AVE
COLLINGSWOOD NJ
08108-3015
US

IV. Provider business mailing address

108 W COLLINGS AVE
COLLINGSWOOD NJ
08108-3015
US

V. Phone/Fax

Practice location:
  • Phone: 856-858-0294
  • Fax:
Mailing address:
  • Phone: 856-858-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI 02311200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: