Provider Demographics
NPI:1952391096
Name:DAI, MICHELLE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:L
Last Name:DAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LONG LN
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3112
Mailing Address - Country:US
Mailing Address - Phone:610-352-2263
Mailing Address - Fax:610-352-2261
Practice Address - Street 1:101 LONG LN
Practice Address - Street 2:1ST FLOOR
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3112
Practice Address - Country:US
Practice Address - Phone:610-352-2263
Practice Address - Fax:610-352-2261
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031321L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001922048-0001Medicaid