Healthcare Provider Details

I. General information

NPI: 1922015221
Provider Name (Legal Business Name): JOSEPH R MIKULICZ II DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 BRENDIBLE ST
METLAKATLA AK
99926
US

IV. Provider business mailing address

921 S VAL VISTA DR UNIT 109
MESA AZ
85204
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-8295
  • Fax: 480-821-8268
Mailing address:
  • Phone: 602-501-8796
  • Fax: 480-821-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4519
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: