Provider Demographics
NPI:1598103509
Name:LACEY, MEREDITH ALAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ALAINE
Last Name:LACEY
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 1:432 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1812
Mailing Address - Country:US
Mailing Address - Phone:570-592-4829
Mailing Address - Fax:
Practice Address - Street 1:432 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1812
Practice Address - Country:US
Practice Address - Phone:610-377-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0394951223G0001X
MD15728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist