MEDICARE: DR. MICHELLE LYNN MALTESE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901021495	MI

General Provider Information

NPI Number	:	1871976373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE LYNN MALTESE D.D.S.

Provider Business Mailing Address
First Line	:	4741 24 MILE RD STE C
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-3111
Country	:	US
Telephone Number	:	248-652-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 COLLINS RD
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48306-1620
Country	:	US
Telephone Number	:	248-652-3663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/25/2023

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