Provider Demographics
NPI:1396165965
Name:MEEDER, COLBY ALBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:ALBERT
Last Name:MEEDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7675
Mailing Address - Country:US
Mailing Address - Phone:702-540-4404
Mailing Address - Fax:702-540-4404
Practice Address - Street 1:1016 RILEY ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3265
Practice Address - Country:US
Practice Address - Phone:916-605-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014148451223G0001X
TX362451223G0001X, 1223S0112X
KY107071223G0001X, 1223S0112X
390200000X
CA1035561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program