Provider Demographics
NPI:1043667603
Name:AULL, MEAGAN ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:ELIZABETH
Last Name:AULL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ELLEMOOR LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6411
Mailing Address - Country:US
Mailing Address - Phone:270-313-3763
Mailing Address - Fax:
Practice Address - Street 1:2716 OLD ROSEBUD RD STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8007
Practice Address - Country:US
Practice Address - Phone:859-543-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY97561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice