Provider Demographics
NPI:1346381308
Name:TEICH, MICHAEL R (DDS,PC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:TEICH
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9751 N 90TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5082
Mailing Address - Country:US
Mailing Address - Phone:480-860-8282
Mailing Address - Fax:480-860-0725
Practice Address - Street 1:9751 N 90TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5082
Practice Address - Country:US
Practice Address - Phone:480-860-8282
Practice Address - Fax:480-860-0725
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice