Provider Demographics
NPI:1306953401
Name:MACHUGA, MICHAEL GEORGE (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:MACHUGA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 25TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2703
Mailing Address - Country:US
Mailing Address - Phone:814-452-2167
Mailing Address - Fax:814-874-0223
Practice Address - Street 1:225 W 25TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2703
Practice Address - Country:US
Practice Address - Phone:814-452-2167
Practice Address - Fax:814-874-0223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-021197-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice