Provider Demographics
NPI:1285837013
Name:HEZRONI, MICHAL MORAG (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:MORAG
Last Name:HEZRONI
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 1:1500 E MEDICAL CENTER DR
Mailing Address - Street 2:TC BI 304
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-0018
Mailing Address - Country:US
Mailing Address - Phone:734-764-1542
Mailing Address - Fax:734-615-1415
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:TC BI 304
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0018
Practice Address - Country:US
Practice Address - Phone:734-764-1542
Practice Address - Fax:734-615-1415
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191561223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered122300000XDental ProvidersDentist