Healthcare Provider Details

I. General information

NPI: 1700179785
Provider Name (Legal Business Name): MEGHAN MICHELLE MONROE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 3RD ST SUITE 1
ANAMOSA IA
52205-2066
US

IV. Provider business mailing address

6093 FOREST HILLS DR
DUBUQUE IA
52002-9318
US

V. Phone/Fax

Practice location:
  • Phone: 319-462-2313
  • Fax:
Mailing address:
  • Phone: 563-845-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number08822
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: