Individual
DR. THOMAS R MICHAELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
1801 NEWPORT BOULEVARD, SUITE C, COSTA MESA, CA 92627
(949) 650-1030
(949) 722-2481
Mailing address
1401 AVOCADO AVENUE, SUITE 50G, NEWPORT BEACH, CA 92660
(949) 760-1661
(949) 760-8016
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
42745
CA
Other
Enumeration date
12/14/2006
Last updated
07/08/2007
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