Provider Demographics
NPI:1487775375
Name:MEOLA, JOHN D JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MEOLA
Suffix:JR
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 1:52 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1127
Mailing Address - Country:US
Mailing Address - Phone:781-890-4900
Mailing Address - Fax:781-890-6094
Practice Address - Street 1:52 SECOND AVE STE 500
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1114
Practice Address - Country:US
Practice Address - Phone:781-890-4900
Practice Address - Fax:781-890-6094
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN14230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist