Provider Demographics
NPI:1003201112
Name:MEINHARDT, JASON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:MEINHARDT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 S MEMORIAL PL
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3714
Mailing Address - Country:US
Mailing Address - Phone:920-458-7781
Mailing Address - Fax:
Practice Address - Street 1:2115 S MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-458-7781
Practice Address - Fax:920-458-2015
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001453-151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics