Provider Demographics
NPI:1720002785
Name:MEISTER, TAMMY L (DDS, MS, PA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:MEISTER
Suffix:
Gender:F
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1806
Mailing Address - Country:US
Mailing Address - Phone:651-699-2013
Mailing Address - Fax:651-699-2739
Practice Address - Street 1:1696 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1806
Practice Address - Country:US
Practice Address - Phone:651-699-2013
Practice Address - Fax:651-699-2739
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics