Provider Demographics
NPI:1558429407
Name:YILANJIAN, MICHELLE ANN (DMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:YILANJIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2416
Mailing Address - Country:US
Mailing Address - Phone:215-412-3336
Mailing Address - Fax:215-412-0453
Practice Address - Street 1:534 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2416
Practice Address - Country:US
Practice Address - Phone:215-412-3336
Practice Address - Fax:215-412-0453
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0356401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice