Provider Demographics
NPI:1104259266
Name:MEREDITH, JODIE ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ELIZABETH
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7239 MECHANICSVILLE TPKE STE 5
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3557
Mailing Address - Country:US
Mailing Address - Phone:804-730-9414
Mailing Address - Fax:804-730-3664
Practice Address - Street 1:7239 MECHANICSVILLE TPKE STE 5
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3557
Practice Address - Country:US
Practice Address - Phone:804-730-9414
Practice Address - Fax:804-730-3664
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist