Provider Demographics
NPI:1154470763
Name:MICHET DENTAL OFFICES P.C.
Entity Type:Organization
Organization Name:MICHET DENTAL OFFICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:MICHET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-424-2220
Mailing Address - Street 1:9541 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1911
Mailing Address - Country:US
Mailing Address - Phone:708-424-2220
Mailing Address - Fax:
Practice Address - Street 1:9541 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1911
Practice Address - Country:US
Practice Address - Phone:708-424-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty