Provider Demographics
NPI:1407906712
Name:VANPUTTEN, MEADE CARSON JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MEADE
Middle Name:CARSON
Last Name:VANPUTTEN
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-293-8074
Mailing Address - Fax:614-292-8013
Practice Address - Street 1:460 W 10TH AVE FL 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8074
Practice Address - Fax:614-293-3193
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300193501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0833281Medicaid
OHU09055Medicare UPIN
OH0833281Medicaid