Provider Demographics
NPI:1821359035
Name:PETERSON BOYLE, MEGAN CLARE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:CLARE
Last Name:PETERSON BOYLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33739 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1561
Mailing Address - Country:US
Mailing Address - Phone:602-329-6616
Mailing Address - Fax:
Practice Address - Street 1:33739 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1561
Practice Address - Country:US
Practice Address - Phone:602-329-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist