Provider Demographics
NPI:1316925696
Name:IRELAND, MICHAEL G (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:IRELAND
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 1:3605 DUPONT CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2905
Mailing Address - Country:US
Mailing Address - Phone:757-460-6138
Mailing Address - Fax:757-549-9194
Practice Address - Street 1:1230 PROGRESSIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0203
Practice Address - Country:US
Practice Address - Phone:757-549-1049
Practice Address - Fax:757-549-9194
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0083741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008496D69Medicare ID - Type Unspecified