Healthcare Provider Details

I. General information

NPI: 1689795957
Provider Name (Legal Business Name): MICHAEL ALLAN LAMARCA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/13/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MONROE AVE
GREEN BAY WI
54301-4054
US

IV. Provider business mailing address

622 BODART ST
GREEN BAY WI
54301-4923
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-7206
  • Fax: 920-437-0984
Mailing address:
  • Phone: 920-940-8034
  • Fax: 920-437-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-026371
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5598-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: