Provider Demographics
NPI:1447389507
Name:JOHN W MEYER, DDS, P.C.
Entity Type:Organization
Organization Name:JOHN W MEYER, DDS, P.C.
Other - Org Name:CLARKE COUNTY DENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERDENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-342-6079
Mailing Address - Street 1:423 S MAIN STREET
Mailing Address - Street 2:CLARKE COUNTY DENTAL HEALTH CENTER
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213
Mailing Address - Country:US
Mailing Address - Phone:641-342-6079
Mailing Address - Fax:641-342-9729
Practice Address - Street 1:423 S MAIN STREET
Practice Address - Street 2:CLARKE COUNTY DENTAL HEALTH CENTER
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213
Practice Address - Country:US
Practice Address - Phone:641-342-6079
Practice Address - Fax:641-342-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2007963Medicaid