Healthcare Provider Details

I. General information

NPI: 1811563778
Provider Name (Legal Business Name): MYKOLAS VARKALIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208
US

IV. Provider business mailing address

901 COLORADO BLVD APT 5217
DENVER CO
80206-4091
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204863
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901601926
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: