Provider Demographics
NPI:1851508501
Name:DUCH, MICHAEL JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:DUCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15903 BAYVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9606
Mailing Address - Country:US
Mailing Address - Phone:260-627-7108
Mailing Address - Fax:
Practice Address - Street 1:15903 BAYVIEW BLVD
Practice Address - Street 2:
Practice Address - City:GRABILL
Practice Address - State:IN
Practice Address - Zip Code:46741-9606
Practice Address - Country:US
Practice Address - Phone:260-627-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006936A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics