Provider Demographics
NPI:1518060722
Name:DWYER, MICHAEL S (BA DDS MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:DWYER
Suffix:
Gender:M
Credentials:BA DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 110
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3241
Mailing Address - Country:US
Mailing Address - Phone:281-363-2009
Mailing Address - Fax:281-367-5622
Practice Address - Street 1:1001 MEDICAL PLAZA DR
Practice Address - Street 2:STE 110
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3241
Practice Address - Country:US
Practice Address - Phone:281-363-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD110721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118721OtherUNITED CONCORDIA
TX81D741OtherBLUECROSSBLUESHIELD