Provider Demographics
NPI:1225530124
Name:WEST, MICHONNE DANIELLE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MICHONNE
Middle Name:DANIELLE
Last Name:WEST
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 1:161 KELLY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3004
Mailing Address - Country:US
Mailing Address - Phone:256-508-5539
Mailing Address - Fax:256-508-5539
Practice Address - Street 1:310 W ELM ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4802
Practice Address - Country:US
Practice Address - Phone:256-272-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347151223G0001X
390200000X
ALD-0007011-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program