Provider Demographics
NPI:1871606483
Name:LEPCZYK, MICHELENE RILEY (DDS)
Entity type:Individual
Prefix:
First Name:MICHELENE
Middle Name:RILEY
Last Name:LEPCZYK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHELENE
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:20805 E 12 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6502
Mailing Address - Country:US
Mailing Address - Phone:586-773-9660
Mailing Address - Fax:586-773-2640
Practice Address - Street 1:20805 E 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6502
Practice Address - Country:US
Practice Address - Phone:586-773-9660
Practice Address - Fax:586-773-2640
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI119151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice