MEDICARE: DR. MEGAN LERAYE LECORNU D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	62304	CA

General Provider Information

NPI Number	:	1033553961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN LERAYE LECORNU D.M.D.

Provider Business Mailing Address
First Line	:	23206 LYONS AVE STE 206
Second Line	:	SUITE 206
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2672
Country	:	US
Telephone Number	:	661-259-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	23206 LYONS AVE STE 206
Second Line	:	SUITE 206
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2672
Country	:	US
Telephone Number	:	661-259-2388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	05/15/2014

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