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NPI Code Detail

MEDICARE: MEREDITH SICO DMD

MEDICARE: MEREDITH SICO DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry11877TN

General Provider Information

NPI Number : 1003496357
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH SICO DMD
Provider Business Mailing Address
First Line : 6110A CALIFORNIA AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-1321
Country : US
Telephone Number : 361-944-7300
Fax Number :
Provider Business Practice Location Address
First Line : 4502 CHARLOTTE AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37209-3610
Country : US
Telephone Number : 615-647-8421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2021
Last Update Date : 07/19/2022

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Directions to “ MEREDITH SICO DMD” Practice Location

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