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General NPI Number Information
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NPI Number | 1356892657
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Entity Type | Organization
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Legal Business Name | THOMAS R. MICHAELIS, D.D.S., M.D., INC, RYAN M. KRIWANEK, D.D.S., M.D.
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1401 AVOCADO AVE. SUITE 506
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-760-1661
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Fax | 949-760-8016
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Provider Business Mailing Address
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Address Line | 1401 AVOCADO AVE. SUITE 506
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 949-760-1661
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Fax | 949-760-8016
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Authorized Official
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Title or Position | PARTNER
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Name | DR. THOMAS RAYMOND MICHAELIS
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Credential | DDS, MD
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Telephone | 949-760-1661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22313
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 38855
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 42745
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 58948
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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