Provider Demographics
NPI:1275901688
Name:EUGENE V. MEYERDING JR., DMD, PC
Entity Type:Organization
Organization Name:EUGENE V. MEYERDING JR., DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:MEYERDING
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-779-5654
Mailing Address - Street 1:2940 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8161
Mailing Address - Country:US
Mailing Address - Phone:541-779-5654
Mailing Address - Fax:541-779-6909
Practice Address - Street 1:2940 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8161
Practice Address - Country:US
Practice Address - Phone:541-779-5654
Practice Address - Fax:541-779-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty