Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 16394 | FL |
NPI | 1104027929 |
---|---|
Provider Name | Dr. George Joe Meadows JR. |
First Address | Bradenton, FL 34212-2902 |
Second Address | Bradenton, FL 34212-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 28/04/2011 |