Provider Demographics
NPI:1093000499
Name:MEACHAM, DEBRA JAY (DDS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JAY
Last Name:MEACHAM
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 1:2591 S LEATON ROAD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-4600
Mailing Address - Fax:989-775-4680
Practice Address - Street 1:2591 S LEATON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8421
Practice Address - Country:US
Practice Address - Phone:989-775-4600
Practice Address - Fax:989-775-4680
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39447122300000X
MI14604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist