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General NPI Number Information
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NPI Number | 1891847554
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Entity Type | Organization
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Legal Business Name | MEGAN B DESIMONE DDS INC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 26777 LORAIN ROAD SUITE 514
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City | NORTH OLMSTED
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State | OH
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Zip | 44070
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Country | US
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Telephone | 440-734-7373
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Fax | 440-734-4984
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Provider Business Mailing Address
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Address Line | 26777 LORAIN ROAD SUITE 514
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City | NORTH OLMSTED
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State | OH
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Zip | 44070
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Country | US
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Telephone | 440-734-7373
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Fax | 440-734-4984
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. MEGAN BURDICK DESIMONE
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Credential | DDS
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Telephone | 440-734-7373
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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 | 21585
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License Number State | OH
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