Provider Demographics
NPI:1619240447
Name:MERIWETHER, WILLIS JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIS
Middle Name:JAMES
Last Name:MERIWETHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2067
Mailing Address - Country:US
Mailing Address - Phone:205-345-3252
Mailing Address - Fax:205-345-3265
Practice Address - Street 1:600 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE A
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2067
Practice Address - Country:US
Practice Address - Phone:205-345-3252
Practice Address - Fax:205-345-3265
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist