Provider Demographics
NPI:1164658779
Name:MEEUWSEN, ANNE ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELAINE
Last Name:MEEUWSEN
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 1:12374 STAFFORD ST
Mailing Address - Street 2:PO BOX 204
Mailing Address - City:RAVENNA
Mailing Address - State:MI
Mailing Address - Zip Code:49451-5104
Mailing Address - Country:US
Mailing Address - Phone:517-896-8018
Mailing Address - Fax:
Practice Address - Street 1:12374 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451-5104
Practice Address - Country:US
Practice Address - Phone:517-896-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4104122300000X
MI29010204671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist