Healthcare Provider Details

I. General information

NPI: 1639878861
Provider Name (Legal Business Name): MEGAN JOSEPHINE CONLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 WESLEY ST STE A
GREENVILLE TX
75402-6320
US

IV. Provider business mailing address

8210 FLOYD CURL DR
SAN ANTONIO TX
78229-3923
US

V. Phone/Fax

Practice location:
  • Phone: 903-686-1892
  • Fax:
Mailing address:
  • Phone: 210-450-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: