=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992716757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIC MEYER DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2720 N HARBOR BLVD SUITE 110
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-879-7943
-----------------------------------------------------
Fax | 714-879-0754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2720 N HARBOR BLVD SUITE 110
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-879-7943
-----------------------------------------------------
Fax | 714-879-0754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC M. MEYER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 714-879-7943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 37262
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------