Provider Demographics
NPI:1336450550
Name:MAI, MICHELLE XUEYUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:XUEYUN
Last Name:MAI
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 1:16900 E QUINCY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6131
Mailing Address - Country:US
Mailing Address - Phone:303-957-3115
Mailing Address - Fax:
Practice Address - Street 1:16900 E QUINCY AVE STE B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6131
Practice Address - Country:US
Practice Address - Phone:303-957-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002039371223G0001X
NY0555391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty