Provider Demographics
NPI:1043584196
Name:JEFFREY A. MELTZER, D.M.D.,P.C.
Entity Type:Organization
Organization Name:JEFFREY A. MELTZER, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-637-4466
Mailing Address - Street 1:516 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1537
Mailing Address - Country:US
Mailing Address - Phone:315-637-4466
Mailing Address - Fax:315-637-8874
Practice Address - Street 1:516 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1537
Practice Address - Country:US
Practice Address - Phone:315-637-4466
Practice Address - Fax:315-637-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0294351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54877BMedicare UPIN