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General NPI Number Information
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NPI Number | 1598170466
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Entity Type | Individual
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Provider Name | JONATHAN R MEYER DDS
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 4407 MILTON AVE STE 124
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City | JANESVILLE
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State | WI
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Zip | 53546-9155
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Country | US
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Telephone | 608-305-4668
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Fax |
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Provider Business Mailing Address
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Address Line | 4407 MILTON AVE STE 124
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City | JANESVILLE
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State | WI
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Zip | 53546-9155
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Country | US
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Telephone | 608-305-4668
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Fax | 608-352-7339
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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 | 7287-15
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License Number State | WI
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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 | 7287-15
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License Number State | WI
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