Provider Demographics
NPI:1437559820
Name:ON SITE DENTAL SURGERY
Entity Type:Organization
Organization Name:ON SITE DENTAL SURGERY
Other - Org Name:DAVID MEISNER LONE WOLF LLC SINGLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEISNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-915-7722
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-1089
Mailing Address - Country:US
Mailing Address - Phone:303-915-7722
Mailing Address - Fax:303-652-0464
Practice Address - Street 1:376 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80544
Practice Address - Country:US
Practice Address - Phone:303-915-7722
Practice Address - Fax:303-652-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1040241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty