Provider Demographics
NPI:1235167651
Name:GIVENS, MICHAEL ODELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ODELL
Last Name:GIVENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9710
Mailing Address - Country:US
Mailing Address - Phone:704-564-5981
Mailing Address - Fax:
Practice Address - Street 1:8305 UNIVERSITY EXEC PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3357
Practice Address - Country:US
Practice Address - Phone:704-547-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993226Medicaid