Provider Demographics
NPI:1932563319
Name:MEYER, PAUL JUEL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JUEL
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2653
Mailing Address - Country:US
Mailing Address - Phone:605-692-7511
Mailing Address - Fax:
Practice Address - Street 1:105 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2653
Practice Address - Country:US
Practice Address - Phone:605-692-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD11451223X0400X
MND136671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics