Healthcare Provider Details

I. General information

NPI: 1184766214
Provider Name (Legal Business Name): MICHAEL WILLIAM SHEETS D.D.S., D.M.D., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 NW PROFESSIONAL DR
CORVALLIS OR
97330-3991
US

IV. Provider business mailing address

2434 NW PROFESSIONAL DR
CORVALLIS OR
97330-3991
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-3604
  • Fax: 541-758-4360
Mailing address:
  • Phone: 541-758-3604
  • Fax: 541-758-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5811
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: