Provider Demographics
NPI:1467763763
Name:HACK, MICHELLE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANNE
Last Name:HACK
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 1:8221 RITCHIE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3938
Mailing Address - Country:US
Mailing Address - Phone:443-386-5647
Mailing Address - Fax:
Practice Address - Street 1:8221 RITCHIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3938
Practice Address - Country:US
Practice Address - Phone:443-386-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD145441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program