Provider Demographics
NPI:1265442347
Name:MICHAELS, BERNARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 LAWRENCE BELL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7817
Mailing Address - Country:US
Mailing Address - Phone:716-634-4679
Mailing Address - Fax:716-634-5415
Practice Address - Street 1:9290 BOSTON STATE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:NY
Practice Address - Zip Code:14025-9604
Practice Address - Country:US
Practice Address - Phone:716-941-5352
Practice Address - Fax:716-941-5566
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0395091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice