MEDICARE: ZACHARY MEYER, DDS, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1326763467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACHARY MEYER, DDS, PLLC

Provider Business Mailing Address
First Line	:	2485 FORT CAMPBELL BLVD STE 101
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-7789
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 FORT CAMPBELL BLVD STE 101
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-7789
Country	:	US
Telephone Number	:	931-431-0200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ZACHARY MEYER
Credential	:	DDS
Telephone Number	:	931-431-0200

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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