Provider Demographics
NPI:1609052760
Name:MICHEL, ALICIA E (DMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:E
Last Name:MICHEL
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 1:288 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3015
Mailing Address - Country:US
Mailing Address - Phone:845-838-0086
Mailing Address - Fax:845-838-1278
Practice Address - Street 1:288 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3015
Practice Address - Country:US
Practice Address - Phone:845-838-0086
Practice Address - Fax:845-838-1278
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053489-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2898479Medicaid