Provider Demographics
NPI:1356442958
Name:GUEST, MICHAEL J JR (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GUEST
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19557 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2859
Mailing Address - Country:US
Mailing Address - Phone:313-885-7776
Mailing Address - Fax:313-885-0032
Practice Address - Street 1:19557 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2859
Practice Address - Country:US
Practice Address - Phone:313-885-7776
Practice Address - Fax:313-885-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010150831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice