Healthcare Provider Details

I. General information

NPI: 1790192862
Provider Name (Legal Business Name): MEAGAN THOMAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 4TH AVE
INDIALANTIC FL
32903-4213
US

IV. Provider business mailing address

329 4TH AVE
INDIALANTIC FL
32903-4213
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-5242
  • Fax: 321-676-3230
Mailing address:
  • Phone: 321-723-5242
  • Fax: 321-676-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: