Provider Demographics
NPI:1891535605
Name:MEYER, TRISTAN DAVID (DDS)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:DAVID
Last Name:MEYER
Suffix:
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 1:15496 RAMGA RD
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9448
Mailing Address - Country:US
Mailing Address - Phone:567-204-3599
Mailing Address - Fax:
Practice Address - Street 1:809 REDSKIN TRL
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-8546
Practice Address - Country:US
Practice Address - Phone:419-738-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH027559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist