Provider Demographics
NPI:1891800413
Name:MESHKOV-REED DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:MESHKOV-REED DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MESHKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-535-0874
Mailing Address - Street 1:6421 BUSTLETON AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2905
Mailing Address - Country:US
Mailing Address - Phone:215-535-0874
Mailing Address - Fax:215-535-3330
Practice Address - Street 1:6421 BUSTLETON AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2905
Practice Address - Country:US
Practice Address - Phone:215-535-0874
Practice Address - Fax:215-535-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022657L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty