Healthcare Provider Details

I. General information

NPI: 1124176599
Provider Name (Legal Business Name): CHRISTINE RENE MUZYCHKA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4053 S.LAPEER RD SUITE B
METAMORA MI
48455
US

IV. Provider business mailing address

4053 S. LAPEER RD SUITE B
METAMORA MI
48455
US

V. Phone/Fax

Practice location:
  • Phone: 810-678-2244
  • Fax: 810-678-3668
Mailing address:
  • Phone: 810-678-2244
  • Fax: 810-678-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: