Provider Demographics
NPI:1851914626
Name:COBURN, MEGAN (DDS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:COBURN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:1347 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1513
Practice Address - Country:US
Practice Address - Phone:304-743-1407
Practice Address - Fax:304-743-4516
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
WV4453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program