Provider Demographics
NPI:1023594744
Name:MEUNIER, JAMIE LEE (DMD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:MEUNIER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2628
Mailing Address - Country:US
Mailing Address - Phone:920-794-8947
Mailing Address - Fax:
Practice Address - Street 1:1509 19TH ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2628
Practice Address - Country:US
Practice Address - Phone:920-794-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001869-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist