MEDICARE: EMMA MARIE MEYER 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12013190A	IN

General Provider Information

NPI Number	:	1326539362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA MARIE MEYER DDS

Provider Business Mailing Address
First Line	:	9901 AUBURN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2345
Country	:	US
Telephone Number	:	260-489-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 AUBURN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2345
Country	:	US
Telephone Number	:	260-489-0001
Fax Number	:

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

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	12/21/2022

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