Provider Demographics
NPI:1477710895
Name:MEINHARDT, MARK PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILLIP
Last Name:MEINHARDT
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:GENESEE DEPOT
Mailing Address - State:WI
Mailing Address - Zip Code:53127-0068
Mailing Address - Country:US
Mailing Address - Phone:262-968-4720
Mailing Address - Fax:
Practice Address - Street 1:S42 W31330 HWY 83
Practice Address - Street 2:
Practice Address - City:GENESEE DEPOT
Practice Address - State:WI
Practice Address - Zip Code:53127
Practice Address - Country:US
Practice Address - Phone:262-968-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50021031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice