Provider Demographics
NPI:1760737282
Name:HEMINGWAY, MICHAEL
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HEMINGWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 BUTTERFIELD BLVD
Mailing Address - Street 2:160
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8108
Mailing Address - Country:US
Mailing Address - Phone:408-778-3384
Mailing Address - Fax:
Practice Address - Street 1:18181 BUTTERFIELD BLVD
Practice Address - Street 2:160
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8108
Practice Address - Country:US
Practice Address - Phone:408-778-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA572861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice