MEDICARE: TAMMY L. MEISTER D.D.S., M.S., P.A.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10131	MN

General Provider Information

NPI Number	:	1720002785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY L. MEISTER D.D.S., M.S., P.A.

Provider Business Mailing Address
First Line	:	1696 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1806
Country	:	US
Telephone Number	:	651-699-2013
Fax Number	:	651-699-2739

Provider Business Practice Location Address
First Line	:	1696 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1806
Country	:	US
Telephone Number	:	651-699-2013
Fax Number	:	651-699-2739

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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