Healthcare Provider Details

I. General information

NPI: 1285258723
Provider Name (Legal Business Name): DAVID MICHAELS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CENTRAL ST
NORWOOD MA
02062-3503
US

IV. Provider business mailing address

48 TRAYER RD
CANTON MA
02021-3844
US

V. Phone/Fax

Practice location:
  • Phone: 617-455-7660
  • Fax:
Mailing address:
  • Phone: 617-455-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1858688
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: