Provider Demographics
NPI:1174716153
Name:BURRELL, MICHAEL DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:BURRELL
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 1:2229 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4543
Mailing Address - Country:US
Mailing Address - Phone:989-354-8112
Mailing Address - Fax:989-354-3542
Practice Address - Street 1:2229 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4543
Practice Address - Country:US
Practice Address - Phone:989-354-8112
Practice Address - Fax:989-354-3542
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist