Provider Demographics
NPI:1346810801
Name:GAITENS, MEGHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:
Last Name:GAITENS
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 1:152 PARK TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-8899
Mailing Address - Country:US
Mailing Address - Phone:941-313-4560
Mailing Address - Fax:
Practice Address - Street 1:3980 WILSON RD
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9985
Practice Address - Country:US
Practice Address - Phone:984-203-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.9926122300000X, 1223G0001X
NC136261223G0001X
FLDN25878122300000X
FL25878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist