Provider Demographics
NPI:1598964272
Name:KITZROW, MICHELLE LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNNE
Last Name:KITZROW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1737
Mailing Address - Country:US
Mailing Address - Phone:616-772-6933
Mailing Address - Fax:
Practice Address - Street 1:243 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1737
Practice Address - Country:US
Practice Address - Phone:616-772-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010196091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice