Provider Demographics
NPI:1245264266
Name:BAJJALIEH, MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BAJJALIEH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 INDEPENDENCE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5710
Mailing Address - Country:US
Mailing Address - Phone:205-802-7277
Mailing Address - Fax:205-802-7279
Practice Address - Street 1:3500 INDEPENDENCE DR
Practice Address - Street 2:STE 100
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2687
Practice Address - Country:US
Practice Address - Phone:205-802-7277
Practice Address - Fax:205-802-7279
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1245264266Medicaid