Healthcare Provider Details

I. General information

NPI: 1467948539
Provider Name (Legal Business Name): GREGORY JAMES MEIGHEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 STERNBERG AVE
FORT EUSTIS VA
23604-1526
US

IV. Provider business mailing address

577 STERNBERG AVE
FORT EUSTIS VA
23604-1526
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401417649
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16416
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16416
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: