MEDICARE: DR. GERALD MEREDITH DDS, MS

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
1	1223P0300X	Periodontics	1630	HI

General Provider Information

NPI Number	:	1093749780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD MEREDITH DDS, MS

Provider Business Mailing Address
First Line	:	500 ALA MOANA BLVD
Second Line	:	SUITE 7-220
City	:	HONOLULU
State	:	HI
Zip	:	96813-4920
Country	:	US
Telephone Number	:	808-523-3103
Fax Number	:	808-523-3122

Provider Business Practice Location Address
First Line	:	500 ALA MOANA BLVD
Second Line	:	SUITE 7-300
City	:	HONOLULU
State	:	HI
Zip	:	96813-4920
Country	:	US
Telephone Number	:	808-536-4332
Fax Number	:	808-537-6640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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