Healthcare Provider Details

I. General information

NPI: 1740339027
Provider Name (Legal Business Name): CRAIG L. MEADOWS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 TAVERN RD
MARTINSBURG WV
25401-2841
US

IV. Provider business mailing address

111 TAVERN RD
MARTINSBURG WV
25401-2841
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3928
  • Fax: 304-267-4618
Mailing address:
  • Phone: 304-267-3928
  • Fax: 304-267-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2742
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: