MEDICARE: DR. ALAN DREW MEILSTRUP 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	122300000X	Dentist	137750	UT

General Provider Information

NPI Number	:	1629085923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN DREW MEILSTRUP DDS

Provider Business Mailing Address
First Line	:	1945 E 125 S
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84040-3166
Country	:	US
Telephone Number	:	801-547-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 W 1000 N
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-1605
Country	:	US
Telephone Number	:	801-595-1313
Fax Number	:

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

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

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