Provider Demographics
NPI:1073617486
Name:WEAR, MICHELLE LYNAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNAE
Last Name:WEAR
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 1:161 THOMAS JOHNSON DR STE 240
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4314
Mailing Address - Country:US
Mailing Address - Phone:301-662-0222
Mailing Address - Fax:301-662-2034
Practice Address - Street 1:161 THOMAS JOHNSON DR STE 240
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4314
Practice Address - Country:US
Practice Address - Phone:301-662-0222
Practice Address - Fax:301-662-2034
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist