Provider Demographics
NPI:1972673911
Name:BOTTIN, MICHELLE RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:BOTTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 LENA CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2959
Mailing Address - Country:US
Mailing Address - Phone:651-452-4111
Mailing Address - Fax:651-452-8824
Practice Address - Street 1:1625 LENA COURT
Practice Address - Street 2:SUITE A
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2959
Practice Address - Country:US
Practice Address - Phone:651-452-4111
Practice Address - Fax:651-452-8824
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice