Provider Demographics
NPI:1528640901
Name:MACAULEY, MERIAM (DDS)
Entity type:Individual
Prefix:
First Name:MERIAM
Middle Name:
Last Name:MACAULEY
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 1:690 FAIRMONT DR UNIT 205
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3567
Mailing Address - Country:US
Mailing Address - Phone:732-979-4788
Mailing Address - Fax:
Practice Address - Street 1:3233 SUPERIOR LN STE B25
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1935
Practice Address - Country:US
Practice Address - Phone:732-979-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028432001223G0001X
MD183431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice