Provider Demographics
NPI:1215066626
Name:MEYER, JAMES PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:MEYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PEPPER GRASS LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-5600
Mailing Address - Country:US
Mailing Address - Phone:920-738-9954
Mailing Address - Fax:
Practice Address - Street 1:1020 TRUMAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2211
Practice Address - Country:US
Practice Address - Phone:920-733-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4115-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice