Healthcare Provider Details

I. General information

NPI: 1265004121
Provider Name (Legal Business Name): JONMICHAL H BILECKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 INAOKACHO,
YOKOSUKA KANAGAWA
2380002
JP

IV. Provider business mailing address

HOSPITAL PO BOX PSC 475 BOX 1310
FPO AP
96350
US

V. Phone/Fax

Practice location:
  • Phone: 814-681-6714
  • Fax:
Mailing address:
  • Phone: 503-349-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11476
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD11476
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: