Provider Demographics
NPI:1447344676
Name:MEADVIN, LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MEADVIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 KINGS HWY S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2579
Mailing Address - Country:US
Mailing Address - Phone:856-429-7811
Mailing Address - Fax:856-429-7819
Practice Address - Street 1:303 KINGS HWY S
Practice Address - Street 2:SUITE 303
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2579
Practice Address - Country:US
Practice Address - Phone:856-429-7811
Practice Address - Fax:856-429-7819
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009331001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics