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General NPI Number Information
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NPI Number | 1033867452
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Entity Type | Individual
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Provider Name | MICHELLE MCMAHAN DDS
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Gender | Female
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 6564 COLORADO HIGHWAY 96
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City | OLNEY SPRINGS
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State | CO
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Zip | 81062
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Country | US
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Telephone | 719-267-3548
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Fax |
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Provider Business Mailing Address
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Address Line | 940 CARLSON DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN00007005
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License Number State | CO
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