Provider Demographics
NPI:1821207853
Name:JEFFREY T. MEISTER, DDS, LLC
Entity Type:Organization
Organization Name:JEFFREY T. MEISTER, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-924-8766
Mailing Address - Street 1:1630 45TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3963
Mailing Address - Country:US
Mailing Address - Phone:219-924-8766
Mailing Address - Fax:219-924-8762
Practice Address - Street 1:1630 45TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3959
Practice Address - Country:US
Practice Address - Phone:219-924-8766
Practice Address - Fax:219-924-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009034A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty