Provider Demographics
NPI:1619215605
Name:MEADOR, CAROLE LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:LEE
Last Name:MEADOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAROLE
Other - Middle Name:LEE
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1329 EAST 32ND STREET,
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-624-6269
Mailing Address - Fax:417-626-2367
Practice Address - Street 1:1329 EAST 32ND STREET,
Practice Address - Street 2:SUITE 6
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-624-6269
Practice Address - Fax:417-626-2367
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0148981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice