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General NPI Number Information
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NPI Number | 1639351497
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Entity Type | Individual
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Provider Name | BRIAN ANDREW MICHALKOW DDS
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Gender | Male
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 2420 OWEN RD SUITE E
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City | FENTON
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State | MI
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Zip | 48430-3417
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Country | US
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Telephone | 810-629-0470
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Fax | 810-629-7999
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Provider Business Mailing Address
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Address Line | 2420 OWEN RD SUITE E
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City | FENTON
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State | MI
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Zip | 48430-3417
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Country | US
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Telephone | 810-629-0470
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Fax | 810-629-7999
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | L977343
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License Number State | MI
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