Provider Demographics
NPI:1720058746
Name:DULLANTY, MICHELLE DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DIANE
Last Name:DULLANTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:DIANE
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:203 E DALKE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8112
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:509-984-1197
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-34571223G0001X
WADE00010510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice