Provider Demographics
NPI:1467158741
Name:GULLEY, MEGAN (RDH)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:GULLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10795 COUNTY ROAD 197A LOT 251
Mailing Address - Street 2:
Mailing Address - City:NATHROP
Mailing Address - State:CO
Mailing Address - Zip Code:81236-7741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:448 E 1ST ST STE 137
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2867
Practice Address - Country:US
Practice Address - Phone:719-530-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025243124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist