Provider Demographics
NPI:1326334897
Name:CONDIT, MEGHAN DUBOIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:DUBOIS
Last Name:CONDIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2641 BOSTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4766
Mailing Address - Country:US
Mailing Address - Phone:734-250-4494
Mailing Address - Fax:
Practice Address - Street 1:7758 20TH AVE
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8524
Practice Address - Country:US
Practice Address - Phone:616-777-3300
Practice Address - Fax:616-777-3320
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023893122300000X
IL019.028639122300000X
MI2901021475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist