Provider Demographics
NPI:1073545810
Name:MEACHUM, TARA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYNN
Last Name:MEACHUM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2625
Mailing Address - Country:US
Mailing Address - Phone:616-754-8631
Mailing Address - Fax:616-754-0519
Practice Address - Street 1:1717 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2625
Practice Address - Country:US
Practice Address - Phone:616-754-8631
Practice Address - Fax:616-754-0519
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI179041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice