Provider Demographics
NPI:1871779827
Name:MEINKE, HEIDI B (DDS)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:B
Last Name:MEINKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3328
Mailing Address - Country:US
Mailing Address - Phone:310-360-8250
Mailing Address - Fax:
Practice Address - Street 1:239 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3328
Practice Address - Country:US
Practice Address - Phone:310-360-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist