Provider Demographics
NPI:1649653460
Name:FANCHER, MEAGAN NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:NICOLE
Last Name:FANCHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:NICOLE
Other - Last Name:ANDRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:215 S RAGSDALE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766
Mailing Address - Country:US
Mailing Address - Phone:903-485-5557
Mailing Address - Fax:903-206-8088
Practice Address - Street 1:215 S RAGSDALE STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4933
Practice Address - Country:US
Practice Address - Phone:903-485-5557
Practice Address - Fax:903-206-8088
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310931223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202843296OtherTAX ID NUMBER