Provider Demographics
NPI:1649333782
Name:MATHESON, MICHELLE M (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:MATHESON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1179 WHITEHALL RD
Mailing Address - Street 2:STE A
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2497
Mailing Address - Country:US
Mailing Address - Phone:231-744-6100
Mailing Address - Fax:231-744-6099
Practice Address - Street 1:1179 WHITEHALL RD
Practice Address - Street 2:SUITE A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2497
Practice Address - Country:US
Practice Address - Phone:231-744-6100
Practice Address - Fax:231-744-6099
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010140371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice