Provider Demographics
NPI:1235388653
Name:MICHAEL, ADELE KATHARINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:KATHARINA
Last Name:MICHAEL
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22183-0339
Mailing Address - Country:US
Mailing Address - Phone:571-331-8964
Mailing Address - Fax:
Practice Address - Street 1:8230 BOONE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2621
Practice Address - Country:US
Practice Address - Phone:571-331-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice