Healthcare Provider Details

I. General information

NPI: 1437379419
Provider Name (Legal Business Name): MICHAEL ALAN WASEMILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-204 HWY 111 STE A
INDIO CA
92201
US

IV. Provider business mailing address

82-204 HWY 111 STE A
INDIO CA
92201
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-5552
  • Fax: 760-775-5002
Mailing address:
  • Phone: 760-775-5552
  • Fax: 760-775-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: