Healthcare Provider Details

I. General information

NPI: 1285946517
Provider Name (Legal Business Name): JOHN DAVID MEISTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 OLD HICKORY BLVD. STE. 101
BRENTWOOD TN
37027-4242
US

IV. Provider business mailing address

1177 OLD HICKORY BLVD. STE. 101
BRENTWOOD TN
37027-4242
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-2603
  • Fax: 615-988-2661
Mailing address:
  • Phone: 615-988-2603
  • Fax: 615-988-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9670
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: