Healthcare Provider Details

I. General information

NPI: 1295997229
Provider Name (Legal Business Name): MEGAN L THOMAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N PROVIDENCE RD
COLUMBIA MO
65203-4365
US

IV. Provider business mailing address

1001 W WORLEY ST
COLUMBIA MO
65203-2037
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8997
  • Fax: 573-442-5208
Mailing address:
  • Phone: 573-214-2314
  • Fax: 573-814-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2008018254
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: