Provider Demographics
NPI:1962516229
Name:MICHAUD, ALAN GREGORY (DDS)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:GREGORY
Last Name:MICHAUD
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 1:3678 ROUTE 9 LAKESHORE
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-5046
Mailing Address - Country:US
Mailing Address - Phone:518-563-4144
Mailing Address - Fax:518-562-8049
Practice Address - Street 1:104 W BAY PLZ
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1785
Practice Address - Country:US
Practice Address - Phone:518-563-8222
Practice Address - Fax:518-562-8049
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist