Individual
DR. MICHAEL TISDELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2216 IVY RD STE 205, CHARLOTTESVILLE, VA 22903-4966
(434) 977-4101
Mailing address
2216 IVY RD STE 205, CHARLOTTESVILLE, VA 22903-4966
(434) 977-4101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007112
VA
Other
Enumeration date
11/03/2006
Last updated
07/08/2007
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