Provider Demographics
NPI:1891124392
Name:PIERCELL, MICHAEL PRIDHAM (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PRIDHAM
Last Name:PIERCELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:860 TECUMSEH RD E
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ON
Mailing Address - Zip Code:N8X 255
Mailing Address - Country:CA
Mailing Address - Phone:519-258-1231
Mailing Address - Fax:519-258-1019
Practice Address - Street 1:860 TECUMSEH RD E
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ON
Practice Address - Zip Code:N8X 255
Practice Address - Country:CA
Practice Address - Phone:519-258-1231
Practice Address - Fax:519-258-1019
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010181081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery