Provider Demographics
NPI:1548453202
Name:STRONG, MICHAEL JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:STRONG
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 1:601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448
Mailing Address - Country:US
Mailing Address - Phone:715-443-2247
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:WI
Practice Address - Zip Code:54448
Practice Address - Country:US
Practice Address - Phone:715-443-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001877015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist