Provider Demographics
NPI:1548507171
Name:MENG DENTISTRY, PLLC
Entity type:Organization
Organization Name:MENG DENTISTRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-543-5647
Mailing Address - Street 1:2315 MCDONALD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7347
Mailing Address - Country:US
Mailing Address - Phone:406-543-5647
Mailing Address - Fax:406-728-2031
Practice Address - Street 1:2315 MCDONALD AVE STE 310
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7347
Practice Address - Country:US
Practice Address - Phone:406-543-5647
Practice Address - Fax:406-728-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT13-8892Medicaid