Provider Demographics
NPI:1922193168
Name:LANCOUR, MICHELLE B (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:B
Last Name:LANCOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 SAW MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-764-0606
Mailing Address - Fax:614-764-0640
Practice Address - Street 1:5880 SAW MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-764-0606
Practice Address - Fax:614-764-0640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist