Healthcare Provider Details

I. General information

NPI: 1881981199
Provider Name (Legal Business Name): POLLY T. MICHAELS, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7135 MARINER BLVD
SPRING HILL FL
34609-1048
US

IV. Provider business mailing address

7135 MARINER BLVD
SPRING HILL FL
34609-1048
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-1100
  • Fax: 352-596-4162
Mailing address:
  • Phone: 352-597-1100
  • Fax: 352-596-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18231
License Number StateFL

VIII. Authorized Official

Name: DR. POLLY T MICHAELS
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 352-597-1100