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NPI Code Detail

MEDICARE: DR. DAVID JACKSON MEADOW D.M.D.

MEDICARE: DR. DAVID JACKSON MEADOW D.M.D.
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
11223G0001XGeneral Practice Dentistry1814SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215070750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID JACKSON MEADOW D.M.D.
Provider Business Mailing Address
First Line : 9600 TWO NOTCH RD STE 8
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-1612
Country : US
Telephone Number : 803-788-3707
Fax Number : 803-788-3701
Provider Business Practice Location Address
First Line : 9600 TWO NOTCH RD STE 8
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-1612
Country : US
Telephone Number : 803-788-3707
Fax Number : 803-788-3701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 07/08/2007

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