MEDICARE: MEGAN M KOTTMAN DDS INC

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

General Provider Information

NPI Number	:	1124668348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGAN M KOTTMAN DDS INC

Provider Business Mailing Address
First Line	:	5040 CALUM WAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4218 HOOVER RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3625
Country	:	US
Telephone Number	:	614-539-2702
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MEGAN M KOTTMAN
Credential	:	DDS
Telephone Number	:	330-904-3898

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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