Provider Demographics
NPI:1073804282
Name:RONDEAU, MEAGAN LACIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:LACIE
Last Name:RONDEAU
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 1:6300 W 143RD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2907
Mailing Address - Country:US
Mailing Address - Phone:913-338-3443
Mailing Address - Fax:913-239-9488
Practice Address - Street 1:6300 W 143RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2907
Practice Address - Country:US
Practice Address - Phone:913-338-3443
Practice Address - Fax:913-239-9488
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS61072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program