Healthcare Provider Details

I. General information

NPI: 1578630109
Provider Name (Legal Business Name): EUGENE V MEYERDING JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 SISKIYOU BLVD
MEDFORD OR
97504-8161
US

IV. Provider business mailing address

2940 SISKIYOU BLVD
MEDFORD OR
97504-8161
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-5654
  • Fax:
Mailing address:
  • Phone: 541-779-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5641
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: