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General NPI Number Information
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NPI Number | 1245334382
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Entity Type | Individual
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Provider Name | MICHAEL JANICH DDS
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 717 WALNUT DRIVE
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City | PASO ROBLES
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State | CA
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Zip | 93446
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Country | US
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Telephone | 805-238-5334
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Fax | 805-238-6470
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Provider Business Mailing Address
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Address Line | 695 OLIVE STREET
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City | MORRO BAY
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State | CA
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Zip | 93442
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Country | US
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Telephone | 805-772-7517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 32644
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License Number State | CA
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