Provider Demographics
NPI:1376859306
Name:MICHEL, RAYNALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYNALD
Middle Name:
Last Name:MICHEL
Suffix:
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 1:3051 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1456
Mailing Address - Country:US
Mailing Address - Phone:954-563-5800
Mailing Address - Fax:
Practice Address - Street 1:3051 N FEDERAL HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1456
Practice Address - Country:US
Practice Address - Phone:954-573-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19473122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program