Provider Demographics
NPI:1720184419
Name:MERIDIAN DENTAL
Entity Type:Organization
Organization Name:MERIDIAN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-820-1400
Mailing Address - Street 1:1842 E BASELINE RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1514
Mailing Address - Country:US
Mailing Address - Phone:480-820-1400
Mailing Address - Fax:480-820-1405
Practice Address - Street 1:1842 E BASELINE RD
Practice Address - Street 2:SUITE B1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1514
Practice Address - Country:US
Practice Address - Phone:480-820-1400
Practice Address - Fax:480-820-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD54741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty