Healthcare Provider Details

I. General information

NPI: 1396843009
Provider Name (Legal Business Name): MICHELLE MARIE PASHLEY DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA STE 1C
LAGUNA HILLS CA
92653-4337
US

IV. Provider business mailing address

10942 HARROGATE PL
SANTA ANA CA
92705-2353
US

V. Phone/Fax

Practice location:
  • Phone: 949-768-4071
  • Fax:
Mailing address:
  • Phone: 312-925-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number137.000670.019.02690
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019026904
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number60053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: