Provider Demographics
NPI:1407812571
Name:DZIURGOT, MICHELLE CLAUDINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:CLAUDINE
Last Name:DZIURGOT
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 1:50202 SCHOENHERR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315
Mailing Address - Country:US
Mailing Address - Phone:586-247-8000
Mailing Address - Fax:586-247-8007
Practice Address - Street 1:50202 SCHOENHERR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-247-8000
Practice Address - Fax:586-247-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice