Healthcare Provider Details

I. General information

NPI: 1104733872
Provider Name (Legal Business Name): MEAGAN MARFOGLIA EPDH, BSDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12224 SW GOOSE LN
BEAVERTON OR
97007-2062
US

IV. Provider business mailing address

12224 SW GOOSE LN
BEAVERTON OR
97007-2062
US

V. Phone/Fax

Practice location:
  • Phone: 415-515-3944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: