Provider Demographics
NPI:1427121961
Name:MEIER, MICHAEL D (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MEIER
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 1:107 W. ANN ST.
Mailing Address - Street 2:PO BOX 440
Mailing Address - City:ROANOKE
Mailing Address - State:IL
Mailing Address - Zip Code:61561-0440
Mailing Address - Country:US
Mailing Address - Phone:309-923-2581
Mailing Address - Fax:309-923-9005
Practice Address - Street 1:107 W. ANN ST.
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:IL
Practice Address - Zip Code:61561-0440
Practice Address - Country:US
Practice Address - Phone:309-923-2581
Practice Address - Fax:309-923-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice