Provider Demographics
NPI:1427333822
Name:SETTER, MICHAEL KOENEN (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KOENEN
Last Name:SETTER
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 SW 1ST AVE
Mailing Address - Street 2:#2L
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2075 SW 1ST AVE
Practice Address - Street 2:#2L
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5314
Practice Address - Country:US
Practice Address - Phone:503-505-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60022749122300000X
MI2901019827122300000X
ORD96741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist