Provider Demographics
NPI:1619460466
Name:MEYER, JAYME BETH (DMD)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:BETH
Last Name:MEYER
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 1:2600 WOODSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3616
Mailing Address - Country:US
Mailing Address - Phone:502-644-0367
Mailing Address - Fax:
Practice Address - Street 1:11737 S PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LEBANON JUNCTION
Practice Address - State:KY
Practice Address - Zip Code:40150-8420
Practice Address - Country:US
Practice Address - Phone:502-833-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice