Provider Demographics
NPI:1831322288
Name:MEASELLS, JOHN WILLEY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLEY
Last Name:MEASELLS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3711
Mailing Address - Country:US
Mailing Address - Phone:601-638-9111
Mailing Address - Fax:601-638-0013
Practice Address - Street 1:1909 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3711
Practice Address - Country:US
Practice Address - Phone:601-638-9111
Practice Address - Fax:601-638-0013
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3514-09122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist