Provider Demographics
NPI:1104922129
Name:MICHAEL MEYER DMD PC
Entity type:Organization
Organization Name:MICHAEL MEYER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-275-7112
Mailing Address - Street 1:1504 DENTAL DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3574
Mailing Address - Country:US
Mailing Address - Phone:812-275-7112
Mailing Address - Fax:812-275-7244
Practice Address - Street 1:1504 DENTAL DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3574
Practice Address - Country:US
Practice Address - Phone:812-275-7112
Practice Address - Fax:812-275-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120070131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty