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General NPI Number Information
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NPI Number | 1992140099
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Entity Type | Organization
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Legal Business Name | MARK MEREDITH, DDS, INC
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 8079 US HWY 165
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City | COLUMBIA
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State | LA
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Zip | 71418
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Country | US
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Telephone | 318-649-6161
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Fax | 318-649-6144
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Provider Business Mailing Address
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Address Line | PO BOX 360
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City | COLUMBIA
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State | LA
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Zip | 71418-0360
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Country | US
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Telephone | 318-649-6161
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Fax | 318-649-6144
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MARK M MEREDITH
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Credential | DDS
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Telephone | 318-649-6161
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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 | 3006
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License Number State | LA
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