Healthcare Provider Details

I. General information

NPI: 1639537277
Provider Name (Legal Business Name): MEREDITH ANN STALNAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH ANN OLIVER DDS

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE MEMPHIS
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

13605 REESE BLVD W
HUNTERSVILLE NC
28078-6250
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-2242
  • Fax:
Mailing address:
  • Phone: 704-948-1111
  • Fax: 704-274-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11265
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS0000010103
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: