Provider Demographics
NPI:1144845991
Name:MEREDITH, GREGORY DERRICK (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DERRICK
Last Name:MEREDITH
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 1:190 WATER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1384
Mailing Address - Country:US
Mailing Address - Phone:740-286-0480
Mailing Address - Fax:740-286-8968
Practice Address - Street 1:190 WATER ST STE 2
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1384
Practice Address - Country:US
Practice Address - Phone:740-286-0480
Practice Address - Fax:740-286-8968
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0261671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice