Provider Demographics
NPI:1093934853
Name:MEADOWS, DAN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:THOMAS
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4620
Mailing Address - Country:US
Mailing Address - Phone:901-452-0040
Mailing Address - Fax:901-452-0256
Practice Address - Street 1:3491 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4620
Practice Address - Country:US
Practice Address - Phone:901-452-0040
Practice Address - Fax:901-452-0256
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS33931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice