Provider Demographics
NPI:1720235914
Name:NIESET, MICHELLE RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RAE
Last Name:NIESET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:RAE
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:601 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2510
Mailing Address - Country:US
Mailing Address - Phone:406-791-9267
Mailing Address - Fax:406-454-7724
Practice Address - Street 1:202 2ND AVE S STE 203
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1831
Practice Address - Country:US
Practice Address - Phone:406-791-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist