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General NPI Number Information
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NPI Number | 1275973166
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Entity Type | Organization
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Legal Business Name | MERIDIAN ENDODONTICS AND PERIODONTICS
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 20350 WATER TOWER BLVD STE 203
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City | BROOKFIELD
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State | WI
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Zip | 53045-3558
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Country | US
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Telephone | 262-327-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 20350 WATER TOWER BLVD STE 203
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City | BROOKFIELD
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State | WI
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Zip | 53045-3558
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Country | US
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Telephone | 262-327-6100
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JARED FRISBIE-TEEL
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Credential |
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Telephone | 262-327-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 6591
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 6852.15
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 6841.15
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License Number State | WI
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