Provider Demographics
NPI:1275854580
Name:MULLIGAN, MEGAN LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LYNN
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LYNN
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4525 TIMBERLINE CT
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6024
Mailing Address - Country:US
Mailing Address - Phone:612-419-0402
Mailing Address - Fax:
Practice Address - Street 1:4525 TIMBERLINE CT
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-6024
Practice Address - Country:US
Practice Address - Phone:612-419-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12786122300000X
WADE602855391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice