Provider Demographics
NPI:1578055950
Name:EQUINDA, MICHELE JACLYN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:JACLYN
Last Name:EQUINDA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2890
Mailing Address - Country:US
Mailing Address - Phone:516-672-3267
Mailing Address - Fax:
Practice Address - Street 1:15 HARRISON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2890
Practice Address - Country:US
Practice Address - Phone:212-758-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0597081223X0400X
IL019.0305851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics