Provider Demographics
NPI:1437353638
Name:PHELAN, MICHAEL KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:PHELAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:4330 S LEE ST BLDG 500
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3072
Mailing Address - Country:US
Mailing Address - Phone:770-271-0833
Mailing Address - Fax:770-614-6460
Practice Address - Street 1:4330 S LEE ST BLDG 500
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3072
Practice Address - Country:US
Practice Address - Phone:770-271-0833
Practice Address - Fax:770-614-6460
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0104181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics