Provider Demographics
NPI:1205213899
Name:MICHEL, BRIAN MATTHEW G (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MATTHEW G
Last Name:MICHEL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S OLDE ONEIDA ST APT 105
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2509
Mailing Address - Country:US
Mailing Address - Phone:414-828-5413
Mailing Address - Fax:
Practice Address - Street 1:2626 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8127
Practice Address - Country:US
Practice Address - Phone:920-231-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10017031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics