Provider Demographics
NPI:1184978157
Name:GRAUL, MEAGAN ELISE (DMD)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ELISE
Last Name:GRAUL
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 1:229 W SAINT LOUIS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-1515
Mailing Address - Country:US
Mailing Address - Phone:618-537-2017
Mailing Address - Fax:
Practice Address - Street 1:229 W SAINT LOUIS ST STE 1
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1515
Practice Address - Country:US
Practice Address - Phone:618-537-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist