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General NPI Number Information
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NPI Number | 1679743470
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Entity Type | Organization
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Legal Business Name | THE KIDS' DENTIST, PLLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 2300 W EVEREST LN SUITE 125
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City | MERIDIAN
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State | ID
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Zip | 83646-5925
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Country | US
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Telephone | 208-938-6343
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Fax | 208-884-5048
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Provider Business Mailing Address
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Address Line | 2300 W EVEREST LN SUITE 125
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City | MERIDIAN
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State | ID
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Zip | 83646-5925
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Country | US
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Telephone | 208-938-6343
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Fax | 208-884-5048
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. LAWRENCE WAYNE MEADORS
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Credential | D.M.D.
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Telephone | 208-938-6343
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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 | D3120PD
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License Number State | ID
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