Provider Demographics
NPI:1568296473
Name:MAGHIRAN, MEGAN KAYE MATIBAG (DDS)
Entity type:Individual
Prefix:
First Name:MEGAN KAYE
Middle Name:MATIBAG
Last Name:MAGHIRAN
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 1:11819 FOOTHILL BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3939
Mailing Address - Country:US
Mailing Address - Phone:909-695-8221
Mailing Address - Fax:
Practice Address - Street 1:11819 FOOTHILL BLVD STE G
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3939
Practice Address - Country:US
Practice Address - Phone:909-476-0538
Practice Address - Fax:909-476-0530
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1106001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice