Provider Demographics
NPI:1639350077
Name:LACUES, MICHELLE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:LACUES
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 1:150 ARCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1345
Mailing Address - Country:US
Mailing Address - Phone:650-366-3112
Mailing Address - Fax:
Practice Address - Street 1:150 ARCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1345
Practice Address - Country:US
Practice Address - Phone:650-366-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist