Healthcare Provider Details

I. General information

NPI: 1144920901
Provider Name (Legal Business Name): MEGAN ELIZABETH PHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 MENCHACA RD STE A
AUSTIN TX
78745-5284
US

IV. Provider business mailing address

7201 MENCHACA RD STE A
AUSTIN TX
78745-5284
US

V. Phone/Fax

Practice location:
  • Phone: 512-444-3623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: