Healthcare Provider Details

I. General information

NPI: 1780292763
Provider Name (Legal Business Name): MICHELLE KATHLEEN SHIPP DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S 18TH AVE
STURGEON BAY WI
54235-1000
US

IV. Provider business mailing address

228 S 18TH AVE
STURGEON BAY WI
54235-1000
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-3788
  • Fax:
Mailing address:
  • Phone: 920-746-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number1002368-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: