Provider Demographics
NPI:1801961636
Name:MICHAELS, DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23200 SE 267TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6830
Mailing Address - Country:US
Mailing Address - Phone:425-765-7019
Mailing Address - Fax:
Practice Address - Street 1:4700 42ND AVE SW STE 460
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4589
Practice Address - Country:US
Practice Address - Phone:206-767-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007572122300000X
CADDS40679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028535Medicaid
WA5028535Medicaid