Healthcare Provider Details

I. General information

NPI: 1043325665
Provider Name (Legal Business Name): MEREDITH FENNELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 CHICORA RD
CHICORA PA
16025
US

IV. Provider business mailing address

PO BOX 375 2016 CHICORA RD
CHICORA PA
16025-0375
US

V. Phone/Fax

Practice location:
  • Phone: 724-445-2558
  • Fax: 724-445-3705
Mailing address:
  • Phone: 724-445-2558
  • Fax: 724-445-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035148
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: