Provider Demographics
NPI:1235921537
Name:WILGUS, MEGAN R (DMD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:R
Last Name:WILGUS
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 1:1665 CARPENTER RD S APT E7
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7975
Mailing Address - Country:US
Mailing Address - Phone:727-242-3579
Mailing Address - Fax:
Practice Address - Street 1:200 12TH ST W STE A
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3900
Practice Address - Country:US
Practice Address - Phone:229-382-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN1238611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program