Provider Demographics
NPI:1568578623
Name:MICHELI, ROBERT L (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:MICHELI
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 1:773 JENEVEIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4230
Mailing Address - Country:US
Mailing Address - Phone:650-588-1775
Mailing Address - Fax:
Practice Address - Street 1:773 JENEVEIN AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4230
Practice Address - Country:US
Practice Address - Phone:650-588-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist