Individual
DR. MICHELLE RENEE MATHIESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MSD
Contact information
Practice address
3005 ROYAL BLVD S, SUITE 200, ALPHARETTA, GA 30022-1409
(770) 680-2335
(770) 710-0317
Mailing address
10930 CRABAPPLE RD STE 106, ROSWELL, GA 30075-5825
(678) 352-1090
(678) 974-1993
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401413477
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN014503
GA
Other
Enumeration date
05/28/2012
Last updated
01/04/2018
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