Provider Demographics
NPI:1639222722
Name:MICHELSEN, RICHARD READ (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:READ
Last Name:MICHELSEN
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 1:9717 ELK GROVE FLORIN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2262
Mailing Address - Country:US
Mailing Address - Phone:916-685-4477
Mailing Address - Fax:
Practice Address - Street 1:9717 ELK GROVE FLORIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2262
Practice Address - Country:US
Practice Address - Phone:916-685-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 236441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice