Provider Demographics
NPI:1912121989
Name:MERIWETHER, S MARK (DMD LLC)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:MARK
Last Name:MERIWETHER
Suffix:
Gender:M
Credentials:DMD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WINTON M BLOUNT LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3501
Mailing Address - Country:US
Mailing Address - Phone:334-271-4544
Mailing Address - Fax:334-271-7172
Practice Address - Street 1:252 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3501
Practice Address - Country:US
Practice Address - Phone:334-271-4544
Practice Address - Fax:334-271-7172
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice