Provider Demographics
NPI:1750334207
Name:MOENNING, MICHELLE WALBERT (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:WALBERT
Last Name:MOENNING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:WALBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7130 SCARLET SAGE CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955
Mailing Address - Country:US
Mailing Address - Phone:941-575-7573
Mailing Address - Fax:
Practice Address - Street 1:522 E MARION AVE
Practice Address - Street 2:3RD FLOOR HARBORSIDE DENTAL ASSOCIATES PA
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950
Practice Address - Country:US
Practice Address - Phone:941-575-9200
Practice Address - Fax:941-639-0305
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist