Healthcare Provider Details

I. General information

NPI: 1669814166
Provider Name (Legal Business Name): MEGGAN LOUISE-KRAUSE MCCONE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGGAN LOUISE KRAUSE D.D.S.

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GRAND RIDGE CT NE SUITE 202
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

1750 GRAND RIDGE CT NE SUITE 202
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-9485
  • Fax: 616-988-9486
Mailing address:
  • Phone: 616-988-9485
  • Fax: 616-988-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901020473
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: