Provider Demographics
NPI:1497838619
Name:RALEIGH, MICHELLE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:RALEIGH
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 1:13715 ULSTER ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8122
Mailing Address - Country:US
Mailing Address - Phone:402-651-6026
Mailing Address - Fax:
Practice Address - Street 1:2800 E 136TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3417
Practice Address - Country:US
Practice Address - Phone:720-872-2892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025383500Medicaid
NE1856302OtherUNITED CONCORDIA PROV. NU
NE05776OtherBCBSNE PROVIDER NUMBER