Provider Demographics
NPI:1063671428
Name:ROBERT M MICHAUD DMD, PA
Entity Type:Organization
Organization Name:ROBERT M MICHAUD DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-935-3585
Mailing Address - Street 1:1311 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7709
Mailing Address - Country:US
Mailing Address - Phone:813-935-3585
Mailing Address - Fax:813-930-9211
Practice Address - Street 1:1311 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7709
Practice Address - Country:US
Practice Address - Phone:813-935-3585
Practice Address - Fax:813-930-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty