Provider Demographics
NPI:1275673402
Name:MEAD, MICHAEL SCOTT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:MEAD
Suffix:JR
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 1:12981 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8086
Mailing Address - Country:US
Mailing Address - Phone:330-699-2523
Mailing Address - Fax:330-699-4070
Practice Address - Street 1:12981 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8086
Practice Address - Country:US
Practice Address - Phone:330-699-2523
Practice Address - Fax:330-699-4070
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0225341223G0001X
IN12010635A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice