Provider Demographics
NPI:1093811457
Name:MICHEL, FREDERICK (DMD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CHURCH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:POULTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05764
Mailing Address - Country:US
Mailing Address - Phone:802-287-4066
Mailing Address - Fax:802-287-2315
Practice Address - Street 1:39 CHURCH ST
Practice Address - Street 2:STE 1
Practice Address - City:POULTNEY
Practice Address - State:VT
Practice Address - Zip Code:05764
Practice Address - Country:US
Practice Address - Phone:802-287-4066
Practice Address - Fax:802-287-2315
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT5621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0001741Medicaid