Healthcare Provider Details

I. General information

NPI: 1992266373
Provider Name (Legal Business Name): MEGAN S UTTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 PRATER WAY
SPARKS NV
89431-4438
US

IV. Provider business mailing address

2020 ROSELITE DR UNIT 302
RENO NV
89502-3362
US

V. Phone/Fax

Practice location:
  • Phone: 775-358-6320
  • Fax:
Mailing address:
  • Phone: 616-430-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES-30562
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7520
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: