Basic Information
| Provider Information | |||||||||
| NPI: | 1043726250 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEGAN M. RAYNOR, DMD, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEGAN M. RAYNOR, DMD, PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 HIGHWAY 49 SOUTH | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044552177 | ||||||||
| FaxNumber: | 7044553816 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 HIGHWAY 49 SOUTH | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044552177 | ||||||||
| FaxNumber: | 7044553816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2017 | ||||||||
| LastUpdateDate: | 12/26/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RAYNOR | ||||||||
| AuthorizedOfficialFirstName: | MEGAN | ||||||||
| AuthorizedOfficialMiddleName: | MORSE | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7045167191 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | 10376 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
ID Information
| ID | Type | State | Issuer | Description | 1699125393 | 01 | NC | NPPES | OTHER |