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General NPI Number Information
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NPI Number | 1336832930
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Entity Type | Individual
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Provider Name | MEGAN DOUGHTY
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Gender | Female
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1149 BOUGHTON ST BLDG B
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City | WATERTOWN
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State | WI
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Zip | 53094-3104
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Country | US
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Telephone | 920-261-0495
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Fax |
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Provider Business Mailing Address
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Address Line | W286S4560 WOODS RD
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City | WAUKESHA
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State | WI
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Zip | 53189-9050
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Country | US
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Telephone | 262-894-6160
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6001167-15
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License Number State | WI
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