Provider Demographics
NPI:1790146538
Name:MEISTER, MATTHEW ADAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
Last Name:MEISTER
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 1:217 BROOK AVE STE B104
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3357
Mailing Address - Country:US
Mailing Address - Phone:973-862-3333
Mailing Address - Fax:
Practice Address - Street 1:217 BROOK AVE # B104
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3357
Practice Address - Country:US
Practice Address - Phone:973-862-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0594211223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics