Healthcare Provider Details

I. General information

NPI: 1801214614
Provider Name (Legal Business Name): MICHELL MAY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELL HUDDLESTON RDH

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SW 102ND ST
OKLAHOMA CITY OK
73139-9003
US

IV. Provider business mailing address

20 SW 102ND ST
OKLAHOMA CITY OK
73139-9003
US

V. Phone/Fax

Practice location:
  • Phone: 405-919-1930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2761
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: