Healthcare Provider Details

I. General information

NPI: 1063687119
Provider Name (Legal Business Name): KAREN M. MEGA, DMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 RESERVOIR AVE
CRANSTON RI
02910-1621
US

IV. Provider business mailing address

567 RESERVOIR AVE
CRANSTON RI
02910-1621
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-2772
  • Fax: 401-781-7270
Mailing address:
  • Phone: 401-781-2772
  • Fax: 401-781-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN M MEGA
Title or Position: OWNER
Credential: DMD
Phone: 401-781-2772