Provider Demographics
NPI:1750430351
Name:MICHET, MARILYN RITA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:RITA
Last Name:MICHET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9541 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1911
Mailing Address - Country:US
Mailing Address - Phone:708-424-2220
Mailing Address - Fax:
Practice Address - Street 1:9541 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1911
Practice Address - Country:US
Practice Address - Phone:708-424-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190200941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice