Provider Demographics
NPI:1457757882
Name:MAY, MICHELLE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:J
Last Name:MAY
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 1:11637 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2129
Mailing Address - Country:US
Mailing Address - Phone:414-259-0665
Mailing Address - Fax:414-259-1057
Practice Address - Street 1:11637 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2129
Practice Address - Country:US
Practice Address - Phone:414-259-0665
Practice Address - Fax:414-259-1057
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4960-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist