Provider Demographics
NPI:1407020548
Name:MEADE FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:MEADE FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:BOOTH
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-895-7199
Mailing Address - Street 1:11301 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8200
Mailing Address - Country:US
Mailing Address - Phone:616-895-7199
Mailing Address - Fax:616-895-5698
Practice Address - Street 1:11301 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8200
Practice Address - Country:US
Practice Address - Phone:616-895-7199
Practice Address - Fax:616-895-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010136641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty