Provider Demographics
NPI:1467891606
Name:MEEK, STEFANIE GARDNER (DDS)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:GARDNER
Last Name:MEEK
Suffix:
Gender:F
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:PO BOX 11020
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0018
Mailing Address - Country:US
Mailing Address - Phone:501-581-3380
Mailing Address - Fax:
Practice Address - Street 1:2700 ALLYSON LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6281
Practice Address - Country:US
Practice Address - Phone:501-730-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9668122300000X
AR39441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist