Provider Demographics
NPI:1801923974
Name:GUEST WOLFE, MEAGHAN ELYCE (DMD)
Entity type:Individual
Prefix:DR
First Name:MEAGHAN
Middle Name:ELYCE
Last Name:GUEST WOLFE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:ELYCE
Other - Last Name:GUEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2975 FORT HENRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-247-2151
Mailing Address - Fax:423-247-1594
Practice Address - Street 1:2975 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4005
Practice Address - Country:US
Practice Address - Phone:423-247-2151
Practice Address - Fax:423-247-1594
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4135122300000X
TN8420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4135OtherDENTIST
TN8420OtherDENTIST