Provider Demographics
NPI:1528047479
Name:POWERS, MICHAEL P (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:POWERS
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 1:1930 SR 59
Mailing Address - Street 2:#E
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240
Mailing Address - Country:US
Mailing Address - Phone:330-678-9942
Mailing Address - Fax:330-678-3365
Practice Address - Street 1:1930 SR 59
Practice Address - Street 2:#E
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-678-9942
Practice Address - Fax:330-678-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-85991223P0106X
OH300185991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH135349222-00OtherBUREAU OF WORKER'S COMP
OH0677754Medicaid
OHT48758Medicare UPIN
OH0677754Medicaid
OHP00612141Medicare ID - Type Unspecified
OH135349222-00OtherBUREAU OF WORKER'S COMP