Provider Demographics
NPI:1013039098
Name:HADDOW, MICHAEL (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HADDOW
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28625 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2701
Mailing Address - Country:US
Mailing Address - Phone:248-569-2056
Mailing Address - Fax:248-569-8987
Practice Address - Street 1:28625 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2701
Practice Address - Country:US
Practice Address - Phone:248-569-2056
Practice Address - Fax:248-569-8987
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI132701223P0300X
MI29010132701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics