Provider Demographics
NPI:1851628382
Name:MERIDETH, SONYA LANNIRE (RDH)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:LANNIRE
Last Name:MERIDETH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 W. CACTUS RD.
Mailing Address - Street 2:#104-221
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:678-642-3257
Mailing Address - Fax:
Practice Address - Street 1:926 E. MCDOWELL RD.
Practice Address - Street 2:STE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-253-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH6356124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist