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General NPI Number Information
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NPI Number | 1073545810
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Entity Type | Individual
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Provider Name | TARA LYNN MEACHUM DDS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 1717 W WASHINGTON ST
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City | GREENVILLE
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State | MI
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Zip | 48838-2625
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Country | US
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Telephone | 616-754-8631
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Fax | 616-754-0519
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Provider Business Mailing Address
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Address Line | 1717 W WASHINGTON ST
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City | GREENVILLE
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State | MI
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Zip | 48838-2625
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Country | US
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Telephone | 616-754-8631
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Fax | 616-754-0519
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17904
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License Number State | MI
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