Provider Demographics
NPI:1093955254
Name:DESROCHES, MEGAN SARAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:SARAH
Last Name:DESROCHES
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:N69W23391 SALEM CT W
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3265
Mailing Address - Country:US
Mailing Address - Phone:262-224-9101
Mailing Address - Fax:
Practice Address - Street 1:N64W24050 MAIN ST SUITE 200
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089
Practice Address - Country:US
Practice Address - Phone:262-820-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6403-0151223G0001X
390200000X
WI6403-151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program