Healthcare Provider Details

I. General information

NPI: 1609958693
Provider Name (Legal Business Name): BRIAN L MEALEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

PO BOX 40397
SAN ANTONIO TX
78229-3900
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-6405
  • Fax: 210-567-2844
Mailing address:
  • Phone: 210-567-6405
  • Fax: 210-567-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13658
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: