Provider Demographics
NPI:1821218520
Name:TIBERIA, MICHELLE JOY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JOY
Last Name:TIBERIA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52856 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3507
Mailing Address - Country:US
Mailing Address - Phone:586-697-5272
Mailing Address - Fax:
Practice Address - Street 1:52856 HAYES RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-3507
Practice Address - Country:US
Practice Address - Phone:586-697-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry