Provider Demographics
NPI:1205329208
Name:PERRIEN, MICHELLE MARIE (RDH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:PERRIEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3375 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1277
Mailing Address - Country:US
Mailing Address - Phone:810-743-7086
Mailing Address - Fax:
Practice Address - Street 1:G3375 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1277
Practice Address - Country:US
Practice Address - Phone:810-743-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902007940124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist