Provider Demographics
NPI:1285085274
Name:WELBORN, MEGAN ELYSE (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ELYSE
Last Name:WELBORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:ELYSE
Other - Last Name:PENTICOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1956 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 NEWTON RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-8004
Practice Address - Country:US
Practice Address - Phone:651-645-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND137171223G0001X
IADDS-101711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice