Provider Demographics
NPI:1194700039
Name:MEREDITH, PATRICIA K (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:K
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 1:236 DSB S.
Mailing Address - Street 2:UNIVERISTY OF IOWA
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240
Mailing Address - Country:US
Mailing Address - Phone:319-335-7114
Mailing Address - Fax:
Practice Address - Street 1:236 DSB S.
Practice Address - Street 2:UNIVERISTY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-335-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA069271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2258806Medicaid
IA2258806Medicaid
IA10794Medicare ID - Type Unspecified