Provider Demographics
NPI:1780352120
Name:DO, MEGAN ANH-THU (DDS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANH-THU
Last Name:DO
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 1:4760 E BASELINE RD APT 2108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4691
Mailing Address - Country:US
Mailing Address - Phone:678-897-8465
Mailing Address - Fax:
Practice Address - Street 1:4717 E RAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6230
Practice Address - Country:US
Practice Address - Phone:480-755-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37805122300000X
AZD0117171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist