Provider Demographics
NPI:1598974685
Name:VERHAVE, MICHELLE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:VERHAVE
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 1:5 MAIN ST.
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:PURDYS
Mailing Address - State:NY
Mailing Address - Zip Code:10578-0369
Mailing Address - Country:US
Mailing Address - Phone:914-277-4656
Mailing Address - Fax:914-277-5512
Practice Address - Street 1:5 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PURDYS
Practice Address - State:NY
Practice Address - Zip Code:10578-0369
Practice Address - Country:US
Practice Address - Phone:914-277-4656
Practice Address - Fax:914-277-5512
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0396791223G0001X
CT0085181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice