Provider Demographics
NPI:1699200774
Name:AMON MEADOWS DMD PC
Entity Type:Organization
Organization Name:AMON MEADOWS DMD PC
Other - Org Name:MEADOWS DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEASOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-799-8499
Mailing Address - Street 1:4687 S ATLANTA RD SE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:VININGS
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1509
Mailing Address - Country:US
Mailing Address - Phone:404-799-8499
Mailing Address - Fax:
Practice Address - Street 1:4687 S ATLANTA RD SE
Practice Address - Street 2:SUITE 214
Practice Address - City:VININGS
Practice Address - State:GA
Practice Address - Zip Code:30339-1509
Practice Address - Country:US
Practice Address - Phone:404-799-8499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty