Provider Demographics
NPI:1992979330
Name:MEADOWS DENTAL ASSOCIATES
Entity type:Organization
Organization Name:MEADOWS DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:I
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-377-3659
Mailing Address - Street 1:4987 RINGWOOD MEADOW
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235
Mailing Address - Country:US
Mailing Address - Phone:941-377-3659
Mailing Address - Fax:941-378-0893
Practice Address - Street 1:4987 RINGWOOD MEADOW
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235
Practice Address - Country:US
Practice Address - Phone:941-377-3659
Practice Address - Fax:941-378-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96981223G0001X
FL131211223G0001X
FLDN167281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty