Provider Demographics
NPI:1457424962
Name:MESCHKE, THOMAS JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:MESCHKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 SHADOW LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1119
Mailing Address - Country:US
Mailing Address - Phone:952-448-4151
Mailing Address - Fax:952-448-6856
Practice Address - Street 1:2634 SHADOW LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1119
Practice Address - Country:US
Practice Address - Phone:952-448-4151
Practice Address - Fax:952-448-6856
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND102521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice