Provider Demographics
NPI:1245566728
Name:HAJDUCH, MEGHAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:M
Last Name:HAJDUCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 W 78TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66216-3068
Mailing Address - Country:US
Mailing Address - Phone:515-554-5392
Mailing Address - Fax:
Practice Address - Street 1:13541 MADISON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1669
Practice Address - Country:US
Practice Address - Phone:816-942-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008009347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1223G001XMedicaid