Provider Demographics
NPI:1376906834
Name:MEACHUM DENTAL CORPORATION
Entity Type:Organization
Organization Name:MEACHUM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA MINH-THU
Authorized Official - Middle Name:
Authorized Official - Last Name:MEACHUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-661-2158
Mailing Address - Street 1:33621 DEL OBISPO ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2100
Mailing Address - Country:US
Mailing Address - Phone:949-661-2158
Mailing Address - Fax:
Practice Address - Street 1:33621 DEL OBISPO ST
Practice Address - Street 2:SUITE G
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2100
Practice Address - Country:US
Practice Address - Phone:949-661-2158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA619411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty