Provider Demographics
NPI:1417934480
Name:MEEHAN, JAMES DAN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAN
Last Name:MEEHAN
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 1:10000 COORS BYP NW STE G218
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4084
Mailing Address - Country:US
Mailing Address - Phone:505-242-4867
Mailing Address - Fax:505-242-4867
Practice Address - Street 1:10000 COORS BYP NW STE G218
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4084
Practice Address - Country:US
Practice Address - Phone:505-242-4867
Practice Address - Fax:505-242-4867
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD10961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD1096OtherDENTAL STATE LIC.