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General NPI Number Information
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NPI Number | 1649333782
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Entity Type | Individual
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Provider Name | MICHELLE M MATHESON DDS
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1179 WHITEHALL RD SUITE A
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City | MUSKEGON
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State | MI
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Zip | 49445-2497
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Country | US
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Telephone | 231-744-6100
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Fax | 231-744-6099
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Provider Business Mailing Address
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Address Line | 1179 WHITEHALL RD STE A
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City | NORTH MUSKEGON
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State | MI
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Zip | 49445-2497
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Country | US
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Telephone | 231-744-6100
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Fax | 231-744-6099
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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 | 2901014037
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License Number State | MI
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