Provider Demographics
NPI:1336553908
Name:BOOE, MEGAN RENEE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:RENEE
Last Name:BOOE
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N 1000 W
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9696
Mailing Address - Country:US
Mailing Address - Phone:812-847-5101
Mailing Address - Fax:
Practice Address - Street 1:1206 N 1000 W
Practice Address - Street 2:SUITE A
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9696
Practice Address - Country:US
Practice Address - Phone:812-847-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012174A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry