Provider Demographics
NPI:1598170466
Name:MEYER, JONATHAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
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 1:4407 MILTON AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-9155
Mailing Address - Country:US
Mailing Address - Phone:608-305-4668
Mailing Address - Fax:608-352-7339
Practice Address - Street 1:4407 MILTON AVE STE 124
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-9155
Practice Address - Country:US
Practice Address - Phone:608-305-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7287-151223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice