Provider Demographics
NPI:1457570301
Name:PICKARD, MICHAEL B (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:PICKARD
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1240 SE BISHOP BLVD
Mailing Address - Street 2:STE. S
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 SE BISHOP BLVD
Practice Address - Street 2:STE. S
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5439
Practice Address - Country:US
Practice Address - Phone:509-332-0674
Practice Address - Fax:509-334-5323
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104881223X0400X
IDD-3952-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics