Healthcare Provider Details

I. General information

NPI: 1780887380
Provider Name (Legal Business Name): WAYNE A. MICHAEL D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 W 15TH ST SUITE 403
PLANO TX
75075-7754
US

IV. Provider business mailing address

3713 W 15TH ST SUITE 403
PLANO TX
75075-7754
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-9242
  • Fax:
Mailing address:
  • Phone: 972-596-9242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23538
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberP6467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: