Basic Information
Provider Information | |||||||||
NPI: | 1477572519 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ASSELIN | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6099 N 1ST ST | ||||||||
Address2: | SUITE 104 | ||||||||
City: | FRESNO | ||||||||
State: | CA | ||||||||
PostalCode: | 937105462 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5594311400 | ||||||||
FaxNumber: | 5594311590 | ||||||||
Practice Location | |||||||||
Address1: | 6099 N 1ST ST | ||||||||
Address2: | SUITE 104 | ||||||||
City: | FRESNO | ||||||||
State: | CA | ||||||||
PostalCode: | 937105462 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5594311400 | ||||||||
FaxNumber: | 5594311590 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 53439 | CA | Y |   | Dental Providers | Dentist | General Practice |
No ID Information.