Provider Demographics
NPI:1407954035
Name:MEYER, ERNEST THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:THOMAS
Last Name:MEYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4548
Mailing Address - Country:US
Mailing Address - Phone:931-553-6959
Mailing Address - Fax:931-553-8659
Practice Address - Street 1:1815 HAYNES ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4548
Practice Address - Country:US
Practice Address - Phone:931-553-6959
Practice Address - Fax:931-553-8659
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0161031OtherBCBS PROVIDER
806412OtherUNITED CONCORDIA PROVIDER