Provider Demographics
NPI:1063672319
Name:CHAMMAH, MICHELE BUSSY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:BUSSY
Last Name:CHAMMAH
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 1:654 MADISON AVE RM 1501
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8431
Mailing Address - Country:US
Mailing Address - Phone:212-754-6045
Mailing Address - Fax:212-826-1258
Practice Address - Street 1:654 MADISON AVE RM 1501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8431
Practice Address - Country:US
Practice Address - Phone:212-754-6045
Practice Address - Fax:212-826-1258
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0380581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics