Provider Demographics
NPI:1386830883
Name:FREDERICK D. MESLOH PC
Entity Type:Organization
Organization Name:FREDERICK D. MESLOH PC
Other - Org Name:RIDDELL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MESLOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-774-7996
Mailing Address - Street 1:33 RIDDELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2025
Mailing Address - Country:US
Mailing Address - Phone:413-774-7996
Mailing Address - Fax:413-774-7271
Practice Address - Street 1:33 RIDDELL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2025
Practice Address - Country:US
Practice Address - Phone:413-774-7996
Practice Address - Fax:413-774-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163671223G0001X
MA131811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty