Provider Demographics
NPI:1548381502
Name:AGAZZI, MICHELLE EMIGH (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:EMIGH
Last Name:AGAZZI
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:
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Mailing Address - Street 1:2923 WEBSTER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3481
Mailing Address - Country:US
Mailing Address - Phone:510-451-5236
Mailing Address - Fax:510-451-6108
Practice Address - Street 1:2923 WEBSTER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3481
Practice Address - Country:US
Practice Address - Phone:510-451-5236
Practice Address - Fax:510-451-6108
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA404301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics