Provider Demographics
NPI:1619124732
Name:MEISHA, DALIA E
Entity Type:Individual
Prefix:DR
First Name:DALIA
Middle Name:E
Last Name:MEISHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 WILLIAMSON RD NE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-5130
Mailing Address - Country:US
Mailing Address - Phone:540-206-2203
Mailing Address - Fax:540-400-0525
Practice Address - Street 1:201 W 8TH ST
Practice Address - Street 2:SUITE 810
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3038
Practice Address - Country:US
Practice Address - Phone:719-562-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10087122300000X
VA04014134301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist