Provider Demographics
NPI:1841312816
Name:MEYERING, PAUL ALLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLAN
Last Name:MEYERING
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 1:27225 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1852
Mailing Address - Country:US
Mailing Address - Phone:586-773-1180
Mailing Address - Fax:586-773-2384
Practice Address - Street 1:27225 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1852
Practice Address - Country:US
Practice Address - Phone:586-773-1180
Practice Address - Fax:586-773-2384
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI139591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750257Medicaid