Provider Demographics
NPI:1184613309
Name:MEADE, BRIAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MEADE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1851
Mailing Address - Country:US
Mailing Address - Phone:734-340-2450
Mailing Address - Fax:734-340-2456
Practice Address - Street 1:1900 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1851
Practice Address - Country:US
Practice Address - Phone:734-340-2450
Practice Address - Fax:734-340-2456
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018847122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN