Healthcare Provider Details

I. General information

NPI: 1205527140
Provider Name (Legal Business Name): MEGAN ELIZABETH GANT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N MEDICAL PARK DR
GREENVILLE MS
38703-7239
US

IV. Provider business mailing address

1550 N MEDICAL PARK DR
GREENVILLE MS
38703-7239
US

V. Phone/Fax

Practice location:
  • Phone: 662-334-9337
  • Fax:
Mailing address:
  • Phone: 662-334-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number112354
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number112890
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: