Provider Demographics
NPI:1851675193
Name:TARTAGLIA, MICHELLE (DMD)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:TARTAGLIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2039 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2249
Mailing Address - Country:US
Mailing Address - Phone:803-276-3371
Mailing Address - Fax:803-321-9042
Practice Address - Street 1:2039 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2249
Practice Address - Country:US
Practice Address - Phone:803-276-3371
Practice Address - Fax:803-321-9042
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038725122300000X
SC8517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist