Healthcare Provider Details

I. General information

NPI: 1730688433
Provider Name (Legal Business Name): MEGAN BUGWEG RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W QUINCY ST
HANCOCK MI
49930-1223
US

IV. Provider business mailing address

PO BOX 150
HANCOCK MI
49930-0150
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-3621
  • Fax: 906-482-3676
Mailing address:
  • Phone: 906-482-3621
  • Fax: 906-482-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902017490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: