Basic Information
| Provider Information | |||||||||
| NPI: | 1538689070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEEKS | ||||||||
| FirstName: | OLANREWAJU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 CRESTWOOD BLVD STE 211 | ||||||||
| Address2: | |||||||||
| City: | IRONDALE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352102056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052716841 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 B Y WILLIAMS SR DR STE 211 | ||||||||
| Address2: | |||||||||
| City: | MIDFIELD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352282218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052716841 | ||||||||
| FaxNumber: | 2052716836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 06/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 6430 | AL | Y | Dental Providers | Dentist |
No ID Information.