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General NPI Number Information
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NPI Number | 1376116723
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Entity Type | Individual
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Provider Name | MICHELE LAUREN VOLCHONOK
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Gender | Female
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 4 DEARFIELD DR STE 104
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City | GREENWICH
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State | CT
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Zip | 06831-5351
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Country | US
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Telephone | 203-293-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 11400 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2815
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Country | US
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Telephone | 856-524-1607
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS043186
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License Number State | PA
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