MEDICARE: DR. LON BRYAN MEADER 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
1	1223G0001X	General Practice Dentistry	0401007973	VA

General Provider Information

NPI Number	:	1285851618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LON BRYAN MEADER D,M,D,

Provider Business Mailing Address
First Line	:	2933 ADAM KEELING RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1041
Country	:	US
Telephone Number	:	757-412-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	5564 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5233
Country	:	US
Telephone Number	:	757-424-1300
Fax Number	:	757-424-0219

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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