MEDICARE: DR. LOUIS WADE MEYER

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	145811	UT

General Provider Information

NPI Number	:	1447337910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS WADE MEYER

Provider Business Mailing Address
First Line	:	4645 MIDLAND DR STE 1
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9507
Country	:	US
Telephone Number	:	801-731-5600
Fax Number	:	801-731-1256

Provider Business Practice Location Address
First Line	:	4645 MIDLAND DR STE 1
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9507
Country	:	US
Telephone Number	:	801-731-5600
Fax Number	:	801-731-1256

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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