Healthcare Provider Details

I. General information

NPI: 1790600369
Provider Name (Legal Business Name): MICHELLE ROBERTS RDH, BSDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-4628
US

IV. Provider business mailing address

16606 ALBRECHT AVE NE
CEDAR SPRINGS MI
49319-9628
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-7464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902014902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: