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General NPI Number Information
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NPI Number | 1710454012
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Entity Type | Organization
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Legal Business Name | MICHELLE L MEEHAN, DDS
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 1465 BURTON ST STE A
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City | SHERIDAN
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State | WY
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Zip | 82801-2746
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Country | US
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Telephone | 307-674-9713
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Fax | 307-673-1299
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Provider Business Mailing Address
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Address Line | 1465 BURTON ST STE A
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City | SHERIDAN
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State | WY
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Zip | 82801-2746
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Country | US
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Telephone | 307-674-9713
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Fax | 307-673-1299
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARLA J HOLTHUS
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Credential |
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Telephone | 307-674-9713
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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 |
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License Number State |
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