Provider Demographics
NPI:1174868178
Name:PAWLOSKI, MICHELLE H (RDH BSDH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:H
Last Name:PAWLOSKI
Suffix:
Gender:F
Credentials:RDH BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POMEROY AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4738
Mailing Address - Country:US
Mailing Address - Phone:203-269-9898
Mailing Address - Fax:
Practice Address - Street 1:25 POMEROY AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4738
Practice Address - Country:US
Practice Address - Phone:203-269-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006589124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist