Provider Demographics
NPI:1700816634
Name:MEISER, MICHELLE L (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:MEISER
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 1:3585 124TH AVE NW
Mailing Address - Street 2:STE 400
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-1006
Mailing Address - Country:US
Mailing Address - Phone:763-767-1524
Mailing Address - Fax:763-767-1528
Practice Address - Street 1:3585 124TH AVE NW
Practice Address - Street 2:STE 400
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-1006
Practice Address - Country:US
Practice Address - Phone:763-767-1524
Practice Address - Fax:763-767-1528
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1511674OtherUNITED CONCORDIA
MN836963100OtherMA
MN98G31MEOtherBLUE CROSS