Michelle Amanda Shalander, RDH
Individual provider Active NPI Dental Hygienist · Luck, WI
NPI 1881242535 · NPPES record last updated Aug 27, 2019
Key facts
- NPI
- 1881242535
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 10417 (WI)
- Practice address
- 308 S 1St Street
Luck, WI 54853 - Phone
- (715) 472-2211
- NPI assigned
- Aug 27, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10417 | WI | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 10417 | WI | Yes |
Addresses
Primary practice location
308 S 1St Street
Luck, WI 54853
Mailing address
PO Box 550
Luck, WI 54853-0550
Phone (715) 472-2211
Other providers in Luck, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.