Healthcare Provider Details

I. General information

NPI: 1730870072
Provider Name (Legal Business Name): MICHELLE MARIE ZULETA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32280 FIVE MILE RD
LIVONIA MI
48154-6112
US

IV. Provider business mailing address

9592 SW 88TH ST
MIAMI FL
33176-1941
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-7010
  • Fax:
Mailing address:
  • Phone: 786-278-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601801
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: