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General NPI Number Information
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NPI Number | 1063671428
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Entity Type | Organization
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Legal Business Name | ROBERT M MICHAUD DMD, PA
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 1311 W BUSCH BLVD
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City | TAMPA
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State | FL
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Zip | 33612-7709
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Country | US
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Telephone | 813-935-3585
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Fax | 813-930-9211
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Provider Business Mailing Address
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Address Line | 1311 W BUSCH BLVD
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City | TAMPA
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State | FL
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Zip | 33612-7709
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Country | US
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Telephone | 813-935-3585
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Fax | 813-930-9211
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT MICHAEL MICHAUD
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Credential | DMD
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Telephone | 813-935-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN17693
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License Number State | FL
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