Provider Demographics
NPI:1215361050
Name:KOILPILLAI, MICHELLE LAUREN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LAUREN
Last Name:KOILPILLAI
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 1:14502 GREENVIEW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3287
Mailing Address - Country:US
Mailing Address - Phone:301-604-0025
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3287
Practice Address - Country:US
Practice Address - Phone:301-604-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist