Provider Demographics
NPI:1811932536
Name:BEDELL, MICHELLE D (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:BEDELL
Suffix:
Gender:F
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2126
Mailing Address - Country:US
Mailing Address - Phone:864-489-2221
Mailing Address - Fax:864-489-2171
Practice Address - Street 1:914 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2126
Practice Address - Country:US
Practice Address - Phone:864-489-2221
Practice Address - Fax:864-489-2171
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice