Provider Demographics
NPI:1134001522
Name:MICHELS PROFESSIONAL DENTAL CORP
Entity type:Organization
Organization Name:MICHELS PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MNAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNNIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-647-1322
Mailing Address - Street 1:10883 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1272
Mailing Address - Country:US
Mailing Address - Phone:805-647-1322
Mailing Address - Fax:805-647-3116
Practice Address - Street 1:10883 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1272
Practice Address - Country:US
Practice Address - Phone:805-647-1322
Practice Address - Fax:805-647-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental