Provider Demographics
NPI:1215152566
Name:GRESZES, MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GRESZES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GERSHBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:342 EDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2825
Mailing Address - Country:US
Mailing Address - Phone:917-399-5096
Mailing Address - Fax:
Practice Address - Street 1:441 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1229
Practice Address - Country:US
Practice Address - Phone:516-379-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048811-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02173348Medicaid