Provider Demographics
NPI:1851448609
Name:MEYER, W. SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:W. SCOTT
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4044 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3800
Mailing Address - Country:US
Mailing Address - Phone:810-385-2273
Mailing Address - Fax:810-385-6285
Practice Address - Street 1:4044 24TH AVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3800
Practice Address - Country:US
Practice Address - Phone:810-385-2273
Practice Address - Fax:810-385-6285
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI167351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice