MEDICARE: LON BRYAN MEADER

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	401007973	VA

General Provider Information

NPI Number	:	1740611797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LON BRYAN MEADER

Provider Business Mailing Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-424-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-424-1300
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LON BRYAN MEADER
Credential	:	DMD
Telephone Number	:	757-424-1300

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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