Provider Demographics
NPI:1447337910
Name:MEYER, LOUIS WADE
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:WADE
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 MIDLAND DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9507
Mailing Address - Country:US
Mailing Address - Phone:801-731-5600
Mailing Address - Fax:801-731-1256
Practice Address - Street 1:4645 MIDLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9507
Practice Address - Country:US
Practice Address - Phone:801-731-5600
Practice Address - Fax:801-731-1256
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1458111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice