Healthcare Provider Details

I. General information

NPI: 1427738855
Provider Name (Legal Business Name): MEGHANA KACHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5328 COLDWATER RD
FORT WAYNE IN
46825-5445
US

IV. Provider business mailing address

5328 COLDWATER RD
FORT WAYNE IN
46825-5445
US

V. Phone/Fax

Practice location:
  • Phone: 432-264-0205
  • Fax:
Mailing address:
  • Phone: 432-264-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12014888A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028660
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: