Provider Demographics
NPI:1982893160
Name:PAGEAU, MEGAN SHAW (DMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SHAW
Last Name:PAGEAU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3010
Mailing Address - Country:US
Mailing Address - Phone:864-282-1935
Mailing Address - Fax:864-282-1955
Practice Address - Street 1:216 SCUFFLETOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7296
Practice Address - Country:US
Practice Address - Phone:864-365-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52551223G0001X
SC8710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice