Healthcare Provider Details

I. General information

NPI: 1720278328
Provider Name (Legal Business Name): MEGAN ELAINE MOYNEUR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 GREENHAVEN DR SUITE D
SACRAMENTO CA
95831-3576
US

IV. Provider business mailing address

7210 GREENHAVEN DR SUITE D
SACRAMENTO CA
95831-3576
US

V. Phone/Fax

Practice location:
  • Phone: 916-422-8680
  • Fax: 916-422-8690
Mailing address:
  • Phone: 916-422-8680
  • Fax: 916-422-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: