Provider Demographics
NPI:1992935530
Name:MEADOR, MICHAEL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MEADOR
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1566
Mailing Address - Country:US
Mailing Address - Phone:850-712-5024
Mailing Address - Fax:
Practice Address - Street 1:825 N ALSTON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3509
Practice Address - Country:US
Practice Address - Phone:251-943-7575
Practice Address - Fax:850-712-5024
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18822122300000X
AL57891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist