Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1001453-15 | WI |
NPI | 1003201112 |
---|---|
Provider Name | Dr. Jason Meinhardt |
First Address | Sheboygan, WI 53081-3714 |
Second Address | Sheboygan, WI 53081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 27/08/2018 |