Provider Demographics
NPI:1225248594
Name:MICHELLE M. MAHOUR DDS PC
Entity Type:Organization
Organization Name:MICHELLE M. MAHOUR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-362-9269
Mailing Address - Street 1:22393 N 76TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2117
Mailing Address - Country:US
Mailing Address - Phone:623-362-9269
Mailing Address - Fax:
Practice Address - Street 1:22393 N 76TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2117
Practice Address - Country:US
Practice Address - Phone:623-362-9269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty