Provider Demographics
NPI:1811031040
Name:EDWARDS, MICHELLE HALUM (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HALUM
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 TIMBER WALK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-7725
Mailing Address - Country:US
Mailing Address - Phone:317-826-8663
Mailing Address - Fax:
Practice Address - Street 1:9865 E 116TH ST
Practice Address - Street 2:100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9231
Practice Address - Country:US
Practice Address - Phone:317-842-8453
Practice Address - Fax:317-842-8741
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010350A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry