Provider Demographics
NPI:1629085923
Name:MEILSTRUP, ALAN DREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DREW
Last Name:MEILSTRUP
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 1:1945 E 125 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-3166
Mailing Address - Country:US
Mailing Address - Phone:801-547-0262
Mailing Address - Fax:
Practice Address - Street 1:1409 W 1000 N
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-1605
Practice Address - Country:US
Practice Address - Phone:801-595-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist