Provider Demographics
NPI:1346854106
Name:WIDTH, MEGAN (DDS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WIDTH
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 1:3950 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4397
Mailing Address - Country:US
Mailing Address - Phone:248-410-4562
Mailing Address - Fax:
Practice Address - Street 1:43050 FORD RD STE 190
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3359
Practice Address - Country:US
Practice Address - Phone:734-667-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016006751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice