Provider Demographics
NPI:1043354657
Name:MICHAUD, TERESA (DDS)
Entity Type:Individual
Prefix:
First Name:TERESA
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 1:849 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3231
Mailing Address - Country:US
Mailing Address - Phone:201-445-1166
Mailing Address - Fax:201-445-3337
Practice Address - Street 1:849 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3231
Practice Address - Country:US
Practice Address - Phone:201-445-1166
Practice Address - Fax:201-445-3337
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22 DI014429001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice