Healthcare Provider Details

I. General information

NPI: 1417934480
Provider Name (Legal Business Name): JAMES DAN MEEHAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COORS BYP NW STE G218
ALBUQUERQUE NM
87114-4084
US

IV. Provider business mailing address

10000 COORS BYP NW STE G218
ALBUQUERQUE NM
87114-4084
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4867
  • Fax: 505-242-4867
Mailing address:
  • Phone: 505-242-4867
  • Fax: 505-242-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD1096
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: