Provider Demographics
NPI:1992958656
Name:DEGARIS, MEGAN ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ANNE
Last Name:DEGARIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:ANNE
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:501 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-1094
Mailing Address - Fax:
Practice Address - Street 1:4305 WESTPORT TER
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:843-685-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45441223G0001X
KY86261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice