Provider Demographics
NPI:1891847554
Name:MEGAN B DESIMONE DDS INC
Entity Type:Organization
Organization Name:MEGAN B DESIMONE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:BURDICK
Authorized Official - Last Name:DESIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-734-7373
Mailing Address - Street 1:26777 LORAIN ROAD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-734-7373
Mailing Address - Fax:440-734-4984
Practice Address - Street 1:26777 LORAIN ROAD
Practice Address - Street 2:SUITE 514
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-734-7373
Practice Address - Fax:440-734-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty