Provider Demographics
NPI:1144523317
Name:MERIDIAN DENTAL
Entity type:Organization
Organization Name:MERIDIAN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-255-3400
Mailing Address - Street 1:4070 N BELT LINE RD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5028
Mailing Address - Country:US
Mailing Address - Phone:972-255-3400
Mailing Address - Fax:972-255-4300
Practice Address - Street 1:4070 N BELT LINE RD
Practice Address - Street 2:SUITE 134
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5028
Practice Address - Country:US
Practice Address - Phone:972-255-3400
Practice Address - Fax:972-255-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty