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General NPI Number Information
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NPI Number | 1679017479
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Entity Type | Individual
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Provider Name | MEGAN CONSTANT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 10393 TORRE AVE STE K
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City | CUPERTINO
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State | CA
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Zip | 95014-3235
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Country | US
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Telephone | 408-996-2909
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Fax |
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Provider Business Mailing Address
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Address Line | 11208 MOUNT CREST DR
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City | CUPERTINO
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State | CA
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Zip | 95014-4755
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Country | US
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Telephone |
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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 | 100363
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 100363
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License Number State | CA
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