Provider Demographics
NPI:1003098724
Name:MICHAUD, OLGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ANDREA CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5346
Mailing Address - Country:US
Mailing Address - Phone:201-845-4901
Mailing Address - Fax:
Practice Address - Street 1:301 BRIDGE PLZ N
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5059
Practice Address - Country:US
Practice Address - Phone:201-346-4660
Practice Address - Fax:201-346-1116
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023585001223P0300X
NY0510961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics