Provider Demographics
NPI:1124285648
Name:MEYER, VERA RENEE POLINTAN (DMD)
Entity type:Individual
Prefix:DR
First Name:VERA RENEE
Middle Name:POLINTAN
Last Name:MEYER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VERA RENEE
Other - Middle Name:ORAIS
Other - Last Name:POLINTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:891 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1916
Mailing Address - Country:US
Mailing Address - Phone:415-456-2273
Mailing Address - Fax:415-456-2273
Practice Address - Street 1:891 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1916
Practice Address - Country:US
Practice Address - Phone:415-456-2273
Practice Address - Fax:415-456-2273
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS36821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist