Provider Demographics
NPI:1306925318
Name:MACARTHUR, KELLY MEGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MEGAN
Last Name:MACARTHUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9494
Mailing Address - Country:US
Mailing Address - Phone:734-657-3202
Mailing Address - Fax:
Practice Address - Street 1:2444 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1822
Practice Address - Country:US
Practice Address - Phone:734-572-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0263761223G0001X
MI29010211611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice