Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 6566 | LA |
NPI | 1306239603 |
---|---|
Provider Name | Andrew Megison |
First Address | Metairie, LA 70001-4255 |
Second Address | Metairie, LA 70001-4255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2015 |
Last Update Date | 06/05/2017 |