Provider Demographics
NPI:1962466292
Name:MEADORS, LAWRENCE WAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:MEADORS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2300 W EVEREST LN
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5925
Mailing Address - Country:US
Mailing Address - Phone:208-938-6343
Mailing Address - Fax:208-884-5048
Practice Address - Street 1:2300 W EVEREST LN
Practice Address - Street 2:SUITE 125
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5925
Practice Address - Country:US
Practice Address - Phone:208-938-6343
Practice Address - Fax:208-884-5048
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDD3120PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry