Provider Demographics
NPI:1144863499
Name:KRELL, MICHELLE MARIE (RDH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:KRELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1156
Mailing Address - Country:US
Mailing Address - Phone:715-403-1817
Mailing Address - Fax:
Practice Address - Street 1:720 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1271
Practice Address - Country:US
Practice Address - Phone:715-532-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11107-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist