Provider Demographics
NPI:1093300063
Name:MEYER AND DANA ORTHODONTICS GILLETTE, PLLC
Entity Type:Organization
Organization Name:MEYER AND DANA ORTHODONTICS GILLETTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:605-343-1500
Mailing Address - Street 1:2620 JACKSON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3478
Mailing Address - Country:US
Mailing Address - Phone:605-646-0034
Mailing Address - Fax:
Practice Address - Street 1:2670 OAKCREST DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5905
Practice Address - Country:US
Practice Address - Phone:307-257-8029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty