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General NPI Number Information
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NPI Number | 1235921537
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Entity Type | Individual
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Provider Name | MEGAN R WILGUS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 200 12TH ST W STE A
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City | TIFTON
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State | GA
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Zip | 31794-3900
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Country | US
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Telephone | 229-382-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 CARPENTER RD S APT E7
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City | TIFTON
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State | GA
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Zip | 31793-7975
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Country | US
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Telephone | 727-242-3579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN123861
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License Number State | GA
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