Provider Demographics
NPI:1922238815
Name:MICHAUD, CHRISTIE LEEANN (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LEEANN
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 CAPE CORAL PKWY W STE 11
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6914
Mailing Address - Country:US
Mailing Address - Phone:954-873-4133
Mailing Address - Fax:
Practice Address - Street 1:1715 CAPE CORAL PKWY W STE 11
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6914
Practice Address - Country:US
Practice Address - Phone:954-873-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18692122300000X
FLDN186921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist