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General NPI Number Information
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NPI Number | 1417143082
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Entity Type | Individual
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Provider Name | MARK ANDREW MICHNA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 350 BON AIR RD SUITE 100
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City | GREENBRAE
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State | CA
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Zip | 94904-1752
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Country | US
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Telephone | 415-461-4614
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Fax | 415-461-4616
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Provider Business Mailing Address
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Address Line | 350 BON AIR RD SUITE 100
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City | GREENBRAE
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State | CA
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Zip | 94904-1752
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Country | US
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Telephone | 415-461-4614
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Fax | 415-461-4616
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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 | 39586
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License Number State | CA
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