MEDICARE: JODIE ELIZABETH MEREDITH DDS

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	122300000X	Dentist	0401414106	VA

General Provider Information

NPI Number	:	1104259266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE ELIZABETH MEREDITH DDS

Provider Business Mailing Address
First Line	:	7239 MECHANICSVILLE TPKE STE 5
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3557
Country	:	US
Telephone Number	:	804-730-9414
Fax Number	:	804-730-3664

Provider Business Practice Location Address
First Line	:	7239 MECHANICSVILLE TPKE STE 5
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3557
Country	:	US
Telephone Number	:	804-730-9414
Fax Number	:	804-730-3664

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

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	03/10/2021

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