Provider Demographics
NPI:1578651444
Name:MEYER, DAVID MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARVIN
Last Name:MEYER
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 1:105 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2653
Mailing Address - Country:US
Mailing Address - Phone:605-692-7511
Mailing Address - Fax:605-692-6957
Practice Address - Street 1:105 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2653
Practice Address - Country:US
Practice Address - Phone:605-692-7511
Practice Address - Fax:605-692-6957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM5071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics