Provider Demographics
NPI:1700908548
Name:MARTIN A. MEGREGIAN D.D.S. & ASSOCIATES
Entity Type:Organization
Organization Name:MARTIN A. MEGREGIAN D.D.S. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-453-0300
Mailing Address - Street 1:4245 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8131
Mailing Address - Country:US
Mailing Address - Phone:321-453-0300
Mailing Address - Fax:321-453-8713
Practice Address - Street 1:4245 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8131
Practice Address - Country:US
Practice Address - Phone:321-453-0300
Practice Address - Fax:321-453-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty