Healthcare Provider Details

I. General information

NPI: 1861402356
Provider Name (Legal Business Name): MICHAEL S WOJCIK DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 CONSTITUTION BLVD
STERLING HEIGHTS MI
48313-3801
US

IV. Provider business mailing address

8130 CONSTITUTION BLVD
STERLING HEIGHTS MI
48313-3801
US

V. Phone/Fax

Practice location:
  • Phone: 586-268-5520
  • Fax: 586-268-1288
Mailing address:
  • Phone: 586-268-5520
  • Fax: 586-268-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901015079
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: