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General NPI Number Information
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NPI Number | 1942628250
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Entity Type | Individual
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Provider Name | MAEGAN ELIZABETH DAUGHTERY DDS
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Gender | Female
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 16800 W 12 MILE RD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2108
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Country | US
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Telephone | 248-423-9800
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Fax | 248-423-3486
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Provider Business Mailing Address
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Address Line | 16800 W 12 MILE RD SUITE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2108
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Country | US
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Telephone | 248-423-9800
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Fax | 248-423-3486
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901021773
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30.024693
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License Number State | OH
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