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General NPI Number Information
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NPI Number | 1598059958
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Entity Type | Individual
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Provider Name | MARK OLDAKOWSKI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 714 ABBOT RD
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City | EAST LANSING
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State | MI
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Zip | 48823-3101
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Country | US
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Telephone | 517-337-0351
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Fax |
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Provider Business Mailing Address
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Address Line | 404 W DAVIS AVE
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City | ANN ARBOR
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State | MI
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Zip | 48103-5414
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020377
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License Number State | MI
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