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General NPI Number Information
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NPI Number | 1699141721
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Entity Type | Individual
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Provider Name | MEGAN ELIZABETH OLDRIDGE D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 501 E LAKE ST
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City | HORICON
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State | WI
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Zip | 53032-1264
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Country | US
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Telephone | 920-485-4831
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Fax |
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Provider Business Mailing Address
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Address Line | 501 E LAKE ST
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City | HORICON
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State | WI
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Zip | 53032-1264
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Country | US
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Telephone | 920-485-4831
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.030442
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License Number State | IL
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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 | 1001754-15
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License Number State | WI
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