Provider Demographics
NPI:1447799028
Name:LARAWAY, MEGAN TARA (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:TARA
Last Name:LARAWAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SALLITT DR STE 106
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2285
Mailing Address - Country:US
Mailing Address - Phone:215-913-2297
Mailing Address - Fax:
Practice Address - Street 1:160 SALLITT DR STE 106
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2285
Practice Address - Country:US
Practice Address - Phone:410-604-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry