Provider Demographics
NPI:1952318792
Name:MICHAELSON, GARY HOWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HOWARD
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 N ALAFAYA TRAIL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826
Mailing Address - Country:US
Mailing Address - Phone:407-381-3000
Mailing Address - Fax:407-273-8158
Practice Address - Street 1:1870 N ALAFAYA TRAIL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826
Practice Address - Country:US
Practice Address - Phone:407-381-3000
Practice Address - Fax:407-273-8158
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist