Healthcare Provider Details

I. General information

NPI: 1558158949
Provider Name (Legal Business Name): PEDIATRIC DENTISTRY OF EASTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 DUTCHMANS LN
EASTON MD
21601-4304
US

IV. Provider business mailing address

613 DUTCHMANS LN
EASTON MD
21601-4304
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-7575
  • Fax:
Mailing address:
  • Phone: 410-822-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN LARAWAY
Title or Position: OWNER/DENTIST
Credential:
Phone: 410-822-7575