Provider Demographics
NPI:1649567595
Name:ROBL, MEGAN THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:THERESA
Last Name:ROBL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14856 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6822
Mailing Address - Country:US
Mailing Address - Phone:816-509-9186
Mailing Address - Fax:
Practice Address - Street 1:14856 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6822
Practice Address - Country:US
Practice Address - Phone:816-509-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011098896208600000X
TXQ27011223S0112X
TX305191223S0112X
KS607151223S0112X
PADS0407471223S0112X
NC2013-010191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery