Healthcare Provider Details

I. General information

NPI: 1003989955
Provider Name (Legal Business Name): DENNIS LEE MEIDINGER D.D,S, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 8TH ST NE SUITE 102
AUBURN WA
98002-4700
US

IV. Provider business mailing address

6532 FAIRWAY AVE SE
SNOQUALMIE WA
98065-9773
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-0055
  • Fax: 253-939-2294
Mailing address:
  • Phone: 425-396-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00003970
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: