Provider Demographics
NPI:1376013128
Name:ANDERSON, MICHELE ANNA-MARIE (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNA-MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 N CEDAR AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2698
Mailing Address - Country:US
Mailing Address - Phone:559-439-6600
Mailing Address - Fax:
Practice Address - Street 1:7525 N CEDAR AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2698
Practice Address - Country:US
Practice Address - Phone:559-439-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78314126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty