Provider Demographics
NPI:1255326773
Name:MCMICHAEL, DAVID W (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:MCMICHAEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 DALRAIDA TER
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-1506
Mailing Address - Country:US
Mailing Address - Phone:334-277-3592
Mailing Address - Fax:
Practice Address - Street 1:42 ADOS/SGGN
Practice Address - Street 2:300 SOUTH TWINING ST. BLDG 760
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-7822
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice