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General NPI Number Information
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NPI Number | 1134524424
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Entity Type | Organization
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Legal Business Name | MEADOWS ADULT DENTAL SERVICES SR 64 LLC
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 9916 E STATE ROAD 64
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City | BRADENTON
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State | FL
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Zip | 34212-5303
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Country | US
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Telephone | 941-745-1143
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Fax | 941-708-0555
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Provider Business Mailing Address
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Address Line | 9916 E STATE ROAD 64
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City | BRADENTON
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State | FL
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Zip | 34212-5303
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Country | US
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Telephone | 941-745-1143
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Fax | 941-708-0555
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. GEORGE J MEADOWS JR.
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Credential | DMD
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Telephone | 941-745-1143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | FL
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