Provider Demographics
NPI:1679634570
Name:WASNO, MICHELLE M (DMD)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:M
Last Name:WASNO
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 1:3710 BROADWAY
Mailing Address - Street 2:SUITE102
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5265
Mailing Address - Country:US
Mailing Address - Phone:610-395-0742
Mailing Address - Fax:
Practice Address - Street 1:514 WILD MINT LN
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-8409
Practice Address - Country:US
Practice Address - Phone:610-395-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028634L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice