Provider Demographics
NPI:1558303446
Name:DELAURA, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DELAURA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S. MAIN STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065
Mailing Address - Country:US
Mailing Address - Phone:586-752-2273
Mailing Address - Fax:586-336-7632
Practice Address - Street 1:410 S. MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:586-752-2273
Practice Address - Fax:586-336-7632
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010129681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice