Provider Demographics
NPI:1649215328
Name:MICHELSON, JOEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:C
Last Name:MICHELSON
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 1:605 HILLCREST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:3632 10TH LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6917
Practice Address - Country:US
Practice Address - Phone:507-281-5000
Practice Address - Fax:507-281-5001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND101891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1008933OtherPREFERRED ONE
MN35474MIOtherBCBS
MN0011096OtherDORAL
MN118047OtherUCARE MN
MN35474MIOtherBCBS