Provider Demographics
NPI:1710454012
Name:MICHELLE L MEEHAN, DDS
Entity Type:Organization
Organization Name:MICHELLE L MEEHAN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-674-9713
Mailing Address - Street 1:1465 BURTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2746
Mailing Address - Country:US
Mailing Address - Phone:307-674-9713
Mailing Address - Fax:307-673-1299
Practice Address - Street 1:1465 BURTON ST STE A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2746
Practice Address - Country:US
Practice Address - Phone:307-674-9713
Practice Address - Fax:307-673-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty