Provider Demographics
NPI:1477985844
Name:MEADOWS, JENNIFER (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 COLONIAL BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8703
Mailing Address - Country:US
Mailing Address - Phone:239-210-2926
Mailing Address - Fax:239-210-2929
Practice Address - Street 1:10580 COLONIAL BLVD
Practice Address - Street 2:STE 103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8703
Practice Address - Country:US
Practice Address - Phone:239-210-2926
Practice Address - Fax:239-210-2929
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist