Provider Demographics
NPI:1518036011
Name:MEGAS, TAKIS JOHN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAKIS
Middle Name:JOHN
Last Name:MEGAS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2301
Mailing Address - Country:US
Mailing Address - Phone:413-788-9058
Mailing Address - Fax:413-785-1883
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:SUITE 218
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-788-9058
Practice Address - Fax:413-785-1883
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics