Individual
MR. DENNIS J MICHAELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MS
Contact information
Practice address
2271 OVERLAND AVE, SUITE 4, BURLEY, ID 83318
(208) 678-3265
(208) 678-5206
Mailing address
2271 OVERLAND AVE, SUITE 4, BURLEY, ID 83318
(208) 678-3265
(208) 678-5206
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D1497OR
ID
Other
Enumeration date
10/20/2006
Last updated
07/08/2007
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