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General NPI Number Information
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NPI Number | 1023477312
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Entity Type | Organization
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Legal Business Name | MIKA ORTHODONTICS
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 02/16/2016
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Provider Practice Location Address
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Address Line | 110 N. MAIN ST.
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City | PERRY
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State | MI
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Zip | 48872
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Country | US
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Telephone | 517-625-5552
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Fax | 517-625-5049
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Provider Business Mailing Address
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Address Line | PO BOX 107
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City | PERRY
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State | MI
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Zip | 48872
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Country | US
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Telephone | 517-625-5552
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Fax | 517-625-5049
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHURON RENEE HOLDER
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Credential |
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Telephone | 517-625-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901020672
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License Number State | MI
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