# MERIDIAN DENTAL IMPLANTS & ORAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649199282
- **Authorized official:** JENN HERITAGE (CREDENTIALING MANAGER)
- **Authorized official phone:** (402) 805-4516

## Contact information

- **Practice address:** 1443 BECK AVE, CODY, WY 82414-3730
- **Practice address phone:** (307) 293-2198
- **Practice address fax:** (307) 293-2581
- **Mailing address:** 1443 BECK AVE, CODY, WY 82414-3730
- **Mailing address phone:** (402) 805-4516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2026
- **Last updated:** 10/09/2026