Provider Demographics
NPI:1942718150
Name:PAGEL, MICHELLE R
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:PAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:154 NW 257TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4183
Mailing Address - Country:US
Mailing Address - Phone:352-213-6332
Mailing Address - Fax:
Practice Address - Street 1:14029 W NEWBERRY RD UNIT 60
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669-2792
Practice Address - Country:US
Practice Address - Phone:352-872-5930
Practice Address - Fax:352-872-5932
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH10872124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist