Provider Demographics
NPI:1922408434
Name:MEEUWSEN DENTAL PLLC
Entity Type:Organization
Organization Name:MEEUWSEN DENTAL PLLC
Other - Org Name:RAVENNA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEUWSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-853-6618
Mailing Address - Street 1:12374 STAFFORD ST
Mailing Address - Street 2:PO BOX 204
Mailing Address - City:RAVENNA
Mailing Address - State:MI
Mailing Address - Zip Code:49451-5104
Mailing Address - Country:US
Mailing Address - Phone:231-853-6618
Mailing Address - Fax:231-853-8043
Practice Address - Street 1:12374 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:MI
Practice Address - Zip Code:49451-5104
Practice Address - Country:US
Practice Address - Phone:231-853-6618
Practice Address - Fax:231-853-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental