Individual
DR. JOHN MICHAELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
260 DALWILL DR, MANDEVILLE, LA 70471-3372
(985) 674-1500
Mailing address
260 DALWILL DR, MANDEVILLE, LA 70471-3372
(985) 674-1500
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4187-21
MS
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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