Provider Demographics
NPI:1265640536
Name:SENEGAL, MICHAEL IRONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IRONE
Last Name:SENEGAL
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 1:30 N MICHIGAN AVE
Mailing Address - Street 2:#1029
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-853-3196
Mailing Address - Fax:312-853-0052
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:#1029
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-853-3196
Practice Address - Fax:312-853-0052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.172701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice