Provider Demographics
NPI:1235458688
Name:MEAH FAMILY & COSMETIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:MEAH FAMILY & COSMETIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER/DENTIST CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-684-2884
Mailing Address - Street 1:1350 DORSEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1433
Mailing Address - Country:US
Mailing Address - Phone:410-684-2884
Mailing Address - Fax:410-684-2899
Practice Address - Street 1:1350 DORSEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1433
Practice Address - Country:US
Practice Address - Phone:410-684-2884
Practice Address - Fax:410-684-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136751223G0001X
MD146271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD031397100Medicaid
MD138454600Medicaid