Provider Demographics
NPI:1285851618
Name:MEADER, LON BRYAN (D,M,D,)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:BRYAN
Last Name:MEADER
Suffix:
Gender:M
Credentials:D,M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 ADAM KEELING RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1041
Mailing Address - Country:US
Mailing Address - Phone:757-412-0194
Mailing Address - Fax:
Practice Address - Street 1:5564 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5233
Practice Address - Country:US
Practice Address - Phone:757-424-1300
Practice Address - Fax:757-424-0219
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice