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General NPI Number Information
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NPI Number | 1083343065
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Entity Type | Individual
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Provider Name | MEREDITH DOUGLASS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 7048 OLD CANTON RD
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City | RIDGELAND
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State | MS
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Zip | 39157-1008
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Country | US
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Telephone | 601-853-8904
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Fax |
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Provider Business Mailing Address
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Address Line | 4644 KATHERINE BLVD
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City | JACKSON
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State | MS
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Zip | 39211-5855
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Country | US
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Telephone | 769-777-9669
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4275-22
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License Number State | MS
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