Provider Demographics
NPI:1295028751
Name:SPEIER, MICHELLE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:B
Last Name:SPEIER
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 1:11906 LAKE ESTATES AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7320
Mailing Address - Country:US
Mailing Address - Phone:225-757-8835
Mailing Address - Fax:
Practice Address - Street 1:11906 LAKE ESTATES AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7320
Practice Address - Country:US
Practice Address - Phone:225-757-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6634-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics