Provider Demographics
NPI:1093068223
Name:STOCK, MEGAN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MARIE
Last Name:STOCK
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 1:11676 PERRY HWY
Mailing Address - Street 2:SUITE 1202
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7201
Mailing Address - Country:US
Mailing Address - Phone:724-935-0160
Mailing Address - Fax:724-935-5830
Practice Address - Street 1:11676 PERRY HWY
Practice Address - Street 2:SUITE 1202
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7201
Practice Address - Country:US
Practice Address - Phone:724-935-0160
Practice Address - Fax:724-935-5830
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist