Provider Demographics
NPI:1053383521
Name:ELFORD, MICHELLE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:ELFORD
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 1:18540 W OUTER DR
Mailing Address - Street 2:STE 3
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128
Mailing Address - Country:US
Mailing Address - Phone:313-562-0100
Mailing Address - Fax:313-562-2041
Practice Address - Street 1:18540 W OUTER DR
Practice Address - Street 2:STE 3
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128
Practice Address - Country:US
Practice Address - Phone:313-562-0100
Practice Address - Fax:313-562-2041
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist