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General NPI Number Information
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NPI Number | 1720184419
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Entity Type | Organization
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Legal Business Name | MERIDIAN DENTAL
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1842 E BASELINE RD SUITE B1
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City | TEMPE
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State | AZ
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Zip | 85283-1514
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Country | US
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Telephone | 480-820-1400
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Fax | 480-820-1405
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Provider Business Mailing Address
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Address Line | 1842 E BASELINE RD SUITE B1
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City | TEMPE
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State | AZ
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Zip | 85283-1514
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Country | US
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Telephone | 480-820-1400
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Fax | 480-820-1405
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHELSEA SPIER
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Credential |
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Telephone | 480-820-1400
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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 | D5474
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License Number State | AZ
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