Provider Demographics
NPI:1144423948
Name:MEIER, JACK CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:CHARLES
Last Name:MEIER
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 1:116 WEST SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1401
Mailing Address - Country:US
Mailing Address - Phone:419-874-7291
Mailing Address - Fax:419-874-2823
Practice Address - Street 1:116 WEST SECOND STREET
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1401
Practice Address - Country:US
Practice Address - Phone:419-874-7291
Practice Address - Fax:419-874-2823
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH116471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice