Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 1630 | HI |
NPI | 1093749780 |
---|---|
Provider Name | Dr. Gerald Meredith |
First Address | Honolulu, HI 96813-4920 |
Second Address | Honolulu, HI 96813-4920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |