Provider Demographics
NPI:1104912146
Name:AXELROD, MICHAEL J (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:AXELROD
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 1:1501 PRESIDENTIAL WAY
Mailing Address - Street 2:SUITE #15
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-686-2077
Mailing Address - Fax:561-686-2257
Practice Address - Street 1:1501 PRESIDENTIAL WAY
Practice Address - Street 2:SUITE #15
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-686-2077
Practice Address - Fax:561-686-2257
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice