Provider Demographics
NPI:1699786418
Name:MEYER, RICHARD C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:MEYER
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:10319 W MARKHAM ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2186
Mailing Address - Country:US
Mailing Address - Phone:501-227-4848
Mailing Address - Fax:501-227-5104
Practice Address - Street 1:10319 W MARKHAM ST
Practice Address - Street 2:STE. 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2186
Practice Address - Country:US
Practice Address - Phone:501-227-4848
Practice Address - Fax:501-227-5104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104093608Medicaid