Provider Demographics
NPI:1033256482
Name:MENON, MEERA V (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:V
Last Name:MENON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3241
Mailing Address - Country:US
Mailing Address - Phone:203-925-9425
Mailing Address - Fax:
Practice Address - Street 1:169 CENTER ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3241
Practice Address - Country:US
Practice Address - Phone:203-925-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice