Provider Demographics
NPI:1467821678
Name:SMAIL, MICHELLE THERESA (RDH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THERESA
Last Name:SMAIL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:THERESA
Other - Last Name:SMAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:P.O. BOX 280
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:81423
Mailing Address - Country:US
Mailing Address - Phone:970-327-0527
Mailing Address - Fax:970-327-4235
Practice Address - Street 1:1350 SOUTH ASPEN STREET
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:CO
Practice Address - Zip Code:81423
Practice Address - Country:US
Practice Address - Phone:970-327-0527
Practice Address - Fax:970-327-4235
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH002024117124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist