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NPI Code Detail

MEDICARE: MEGAN M FAIRCLOTH DDS PLLC

MEDICARE: MEGAN M FAIRCLOTH DDS PLLC
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1063153724
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEGAN M FAIRCLOTH DDS PLLC
Provider Business Mailing Address
First Line : 3374 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-4236
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3374 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48207-4236
Country : US
Telephone Number : 313-259-2410
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MEGAN FAIRCLOTH
Credential :
Telephone Number : 313-259-2410
Provider Enumeration Date : 04/06/2022
Last Update Date : 04/06/2022

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