Provider Demographics
NPI:1144077405
Name:MEINZER, TARALYN (RDH, OMT)
Entity type:Individual
Prefix:
First Name:TARALYN
Middle Name:
Last Name:MEINZER
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 CAMBRIA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-5010
Mailing Address - Country:US
Mailing Address - Phone:801-979-4266
Mailing Address - Fax:
Practice Address - Street 1:1034 CAMBRIA DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-5010
Practice Address - Country:US
Practice Address - Phone:801-979-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5359583-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist