Provider Demographics
NPI:1316024029
Name:SUE, MICHELLE CHRISTINE (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:SUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1835 OCEAN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1948
Mailing Address - Country:US
Mailing Address - Phone:541-267-2329
Mailing Address - Fax:541-267-2335
Practice Address - Street 1:1835 OCEAN BLVD SE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1948
Practice Address - Country:US
Practice Address - Phone:541-267-2329
Practice Address - Fax:541-267-2335
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499981223E0200X, 1223E0200X
ORD107531223E0200X
WADE605686171223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics