Provider Demographics
NPI:1245389444
Name:MICHAUD, ROBERT J (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 LONE TREE WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4965
Mailing Address - Country:US
Mailing Address - Phone:925-778-3650
Mailing Address - Fax:925-757-2520
Practice Address - Street 1:2730 LONE TREE WAY STE 6
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4965
Practice Address - Country:US
Practice Address - Phone:925-778-3650
Practice Address - Fax:925-757-2520
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics