Provider Demographics
NPI:1073024980
Name:MOURFIELD, MEGAN ELIZABETH CHARRON (LD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ELIZABETH CHARRON
Last Name:MOURFIELD
Suffix:
Gender:F
Credentials:LD
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:CHARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LD
Mailing Address - Street 1:725 ST HELENS AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-383-3001
Mailing Address - Fax:253-383-4810
Practice Address - Street 1:725 ST HELENS AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-383-3001
Practice Address - Fax:253-383-4810
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60671556122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist