MEDICARE: DR. MEGAN THERESA ROBL M.D.

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	208600000X	Surgery Physician	43011098896	MI
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	Q2701	TX
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30519	TX
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	60715	KS
5	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS040747	PA
6	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2013-01019	NC

General Provider Information

NPI Number	:	1649567595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN THERESA ROBL M.D.

Provider Business Mailing Address
First Line	:	14856 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-6822
Country	:	US
Telephone Number	:	816-509-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	14856 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-6822
Country	:	US
Telephone Number	:	816-509-9186
Fax Number	:

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

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/01/2016

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