Healthcare Provider Details

I. General information

NPI: 1972206035
Provider Name (Legal Business Name): MEAGAN MONTANO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 WEST ST # 202
DANBURY CT
06810-6517
US

IV. Provider business mailing address

138 TOWN GREEN DR
ELMSFORD NY
10523-2318
US

V. Phone/Fax

Practice location:
  • Phone: 203-323-5439
  • Fax:
Mailing address:
  • Phone: 860-508-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14021
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: