Provider Demographics
NPI:1922213495
Name:MEEHAN, MICHELLE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1465 BURTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2745
Mailing Address - Country:US
Mailing Address - Phone:307-674-9713
Mailing Address - Fax:307-673-1973
Practice Address - Street 1:1465 BURTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2745
Practice Address - Country:US
Practice Address - Phone:307-674-9713
Practice Address - Fax:307-673-1973
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY10431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1043OtherSTATE LICENSE NUMBER
WY83-0329217OtherTAX IDENTIFICATION NUMBER