Provider Demographics
NPI:1497494603
Name:MCCREARY-GOCHETT, MYCHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYCHELLE
Middle Name:
Last Name:MCCREARY-GOCHETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MY'CHELLE
Other - Middle Name:
Other - Last Name:GOCHETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:461 DABNEY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1870
Mailing Address - Country:US
Mailing Address - Phone:859-475-8398
Mailing Address - Fax:
Practice Address - Street 1:1100 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4542
Practice Address - Country:US
Practice Address - Phone:202-299-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN20001691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice