Basic Information
| Provider Information | |||||||||
| NPI: | 1639183726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEIER BUHR | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEIER | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.D.S. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187286445 | ||||||||
| FaxNumber: | 2187247003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 10952 | MN | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 820216 | 01 | MN | UNITED CONCORDIA | OTHER | HP34431 | 01 | MN | HEALTH PARTNERS | OTHER | 904481008712 | 01 | MN | PREFERRED ONE | OTHER | 310221008712 | 01 | MN | PREFERRED ONE | OTHER | 04A45ME | 01 | MN | BCBS PROVIDER NUMBER | OTHER |