Provider Demographics
NPI:1770180481
Name:MERIDIAN DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MERIDIAN DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-482-1300
Mailing Address - Street 1:1637 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9701
Mailing Address - Country:US
Mailing Address - Phone:734-482-1300
Mailing Address - Fax:734-482-1309
Practice Address - Street 1:1637 S HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9701
Practice Address - Country:US
Practice Address - Phone:734-482-1300
Practice Address - Fax:734-482-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty