Provider Demographics
NPI:1073608196
Name:MEYER, ELIZABETH A (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MEYER
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 1:709 S MARKET ST
Mailing Address - Street 2:P. O. BOX 3
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014
Mailing Address - Country:US
Mailing Address - Phone:740-599-6882
Mailing Address - Fax:
Practice Address - Street 1:709 S MARKET ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014
Practice Address - Country:US
Practice Address - Phone:740-599-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2220555Medicaid