MEDICARE: MEGAN CATALLOZZI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN03159	RI

General Provider Information

NPI Number	:	1013267715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN CATALLOZZI DDS

Provider Business Mailing Address
First Line	:	320 PHILLIPS ST
Second Line	:	UNIT 104
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5166
Country	:	US
Telephone Number	:	401-295-8806
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 PHILLIPS ST
Second Line	:	UNIT 104
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5166
Country	:	US
Telephone Number	:	401-295-8806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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