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General NPI Number Information
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NPI Number | 1265716724
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Entity Type | Organization
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Legal Business Name | JAMES E MIKULA DDS PC
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 15875 MIDDLEBELT RD SUITE 100
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City | LIVONIA
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State | MI
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Zip | 48154-3884
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Country | US
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Telephone | 734-427-9871
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Fax | 734-427-9874
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Provider Business Mailing Address
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Address Line | 15875 MIDDLEBELT RD SUITE 100
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City | LIVONIA
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State | MI
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Zip | 48154-3884
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Country | US
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Telephone | 734-427-9871
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Fax | 734-427-9874
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Authorized Official
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Title or Position | OWNER
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Name | JAMES EDWARD MIKULA
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Credential | D.D.S.
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Telephone | 734-427-9871
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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 | 14444
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License Number State | MI
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