Provider Demographics
NPI:1699941831
Name:OVANS, MICHELLE A (RDHP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:OVANS
Suffix:
Gender:F
Credentials:RDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 LANGLADE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2738
Mailing Address - Country:US
Mailing Address - Phone:715-627-4383
Mailing Address - Fax:
Practice Address - Street 1:1111 LANGLADE RD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2738
Practice Address - Country:US
Practice Address - Phone:715-627-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10003016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist