MEDICARE: PAUL J MICHELS DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1134863632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL J MICHELS DDS PC

Provider Business Mailing Address
First Line	:	8960 FLETCHER PKWY STE D
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-3298
Country	:	US
Telephone Number	:	619-345-7999
Fax Number	:	619-797-1720

Provider Business Practice Location Address
First Line	:	8960 FLETCHER PKWY STE D
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-3298
Country	:	US
Telephone Number	:	619-345-7999
Fax Number	:	619-797-1720

Authorized Official
Title or Position	:	DENTIST
Name	:	PAUL J MICHELS
Credential	:	DDS
Telephone Number	:	619-345-7999

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

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