Provider Demographics
NPI:1588765887
Name:WILLIS J. MERIWETHER, DMD, PC
Entity type:Organization
Organization Name:WILLIS J. MERIWETHER, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERIWETHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-345-3252
Mailing Address - Street 1:600 A UNIVERSITY BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401
Mailing Address - Country:US
Mailing Address - Phone:205-345-3252
Mailing Address - Fax:205-345-3265
Practice Address - Street 1:600 A UNIVERSITY BLVD EAST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-345-3252
Practice Address - Fax:205-345-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty