Provider Demographics
NPI:1235382706
Name:MATTHEW MEYER D.D.S., P.A.
Entity Type:Organization
Organization Name:MATTHEW MEYER D.D.S., P.A.
Other - Org Name:PARKWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-937-2137
Mailing Address - Street 1:16518 W 78TH ST
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-4302
Mailing Address - Country:US
Mailing Address - Phone:952-937-2137
Mailing Address - Fax:
Practice Address - Street 1:16518 W 78TH ST
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-4302
Practice Address - Country:US
Practice Address - Phone:952-937-2137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11429261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental