Individual
MEGAN GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
89 N MAPLE AVE, RIDGEWOOD, NJ 07450-3235
(201) 797-8899
Mailing address
75 MYRTLE AVE, RAMSEY, NJ 07446-1030
(201) 675-7190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02822100
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/04/2020
Last updated
08/24/2021
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