MEDICARE: DR. JOSEPH WILLIAM MIKOLAJEWSKI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DSO35392	PA

General Provider Information

NPI Number	:	1639345358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WILLIAM MIKOLAJEWSKI DMD

Provider Business Mailing Address
First Line	:	2252 FAUNCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-4020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7258 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1109
Country	:	US
Telephone Number	:	215-728-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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