Provider Demographics
NPI:1013123926
Name:EINHORN, MICHAEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:EINHORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:THORP
Mailing Address - State:WI
Mailing Address - Zip Code:54771-9605
Mailing Address - Country:US
Mailing Address - Phone:715-669-5409
Mailing Address - Fax:
Practice Address - Street 1:202 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:THORP
Practice Address - State:WI
Practice Address - Zip Code:54771-9303
Practice Address - Country:US
Practice Address - Phone:715-669-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001775-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice