Provider Demographics
NPI:1043378664
Name:MEADOWS, FREDERICK JARDEN (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JARDEN
Last Name:MEADOWS
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 1:1178 GRIMES BRIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3935
Mailing Address - Country:US
Mailing Address - Phone:770-992-7550
Mailing Address - Fax:770-992-7868
Practice Address - Street 1:1178 GRIMES BRIDGE RD
Practice Address - Street 2:STE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3935
Practice Address - Country:US
Practice Address - Phone:770-992-7550
Practice Address - Fax:770-992-7868
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
958611OtherUNITED CONCORDIA