=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437371887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KURT E MEYERS D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 W SWEDESFORD ROAD
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-296-9990
-----------------------------------------------------
Fax | 610-296-9993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 WEMBLEY DR
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19087-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-687-0262
-----------------------------------------------------
Fax | 610-296-9993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS021802L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------