| NPI | 1730413261 |
|---|---|
| Former Name | MEGHAN KATHLEEN FAHEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 31686) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6446-015) |
| 1223G0001X Dentist, General Practice (Licence: WI 6446-015) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6446-015) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2019-07-09 |