MEDICARE: MEGAN SHAW PAGEAU DMD

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	5255	AL
2	122300000X	Dentist	8710	SC

General Provider Information

NPI Number	:	1982893160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN SHAW PAGEAU DMD

Provider Business Mailing Address
First Line	:	110 VILLA RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3010
Country	:	US
Telephone Number	:	864-282-1935
Fax Number	:	864-282-1955

Provider Business Practice Location Address
First Line	:	216 SCUFFLETOWN RD
Second Line	:	SUITE D
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-7296
Country	:	US
Telephone Number	:	864-365-0900
Fax Number	:

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

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	11/07/2016

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