Provider Demographics
NPI:1467559021
Name:MICHAELSON, PHILIP L (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CHAGRIN RD
Mailing Address - Street 2:SUITE 20A
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4701
Mailing Address - Country:US
Mailing Address - Phone:440-708-2850
Mailing Address - Fax:440-708-9864
Practice Address - Street 1:8401 CHAGRIN RD
Practice Address - Street 2:SUITE 20A
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4701
Practice Address - Country:US
Practice Address - Phone:440-708-2850
Practice Address - Fax:440-708-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300217181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics