Provider Demographics
NPI:1689011991
Name:MEINHARDT, ADAM JON (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JON
Last Name:MEINHARDT
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 1:3930 N BROOKFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1960
Mailing Address - Country:US
Mailing Address - Phone:262-373-0073
Mailing Address - Fax:
Practice Address - Street 1:3930 N BROOKFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-1960
Practice Address - Country:US
Practice Address - Phone:262-373-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist