Healthcare Provider Details

I. General information

NPI: 1407906712
Provider Name (Legal Business Name): MEADE CARSON VANPUTTEN JR. D.D.S., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE FL 5
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8074
  • Fax: 614-293-3193
Mailing address:
  • Phone: 614-293-8074
  • Fax: 614-292-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30019350
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: