Provider Demographics
NPI:1982055406
Name:JAIN, MEGHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGHA
Middle Name:
Last Name:JAIN
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 1:2429 FREDERICK AVE SIDE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2856
Mailing Address - Country:US
Mailing Address - Phone:443-977-4338
Mailing Address - Fax:
Practice Address - Street 1:2429 FREDERICK AVE SIDE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2856
Practice Address - Country:US
Practice Address - Phone:443-977-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116311223G0001X
MD166371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice