Provider Demographics
NPI:1396884805
Name:MICHAELS, GREGORY C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2549
Mailing Address - Country:US
Mailing Address - Phone:740-654-6628
Mailing Address - Fax:740-654-6578
Practice Address - Street 1:823 N COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2549
Practice Address - Country:US
Practice Address - Phone:740-654-6628
Practice Address - Fax:740-654-6578
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300194381223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology