Provider Demographics
NPI:1346333119
Name:MEHALL, MICHELINE J (RDH 17521)
Entity Type:Individual
Prefix:MISS
First Name:MICHELINE
Middle Name:J
Last Name:MEHALL
Suffix:
Gender:F
Credentials:RDH 17521
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 REFUGIO ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433
Mailing Address - Country:US
Mailing Address - Phone:805-489-4672
Mailing Address - Fax:
Practice Address - Street 1:1370 CHORRO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-543-6535
Practice Address - Fax:805-543-6879
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist