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General NPI Number Information
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NPI Number | 1881893584
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Entity Type | Organization
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Legal Business Name | JOSEPH MIKULICZ DENTAL SERVICES P.C.
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 312 N ALMA SCHOOL RD SUITE 22
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City | CHANDLER
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State | AZ
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Zip | 85224-4354
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Country | US
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Telephone | 480-821-8295
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Fax | 480-821-8268
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Provider Business Mailing Address
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Address Line | 312 N ALMA SCHOOL RD SUITE 22
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City | CHANDLER
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State | AZ
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Zip | 85224-4354
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Country | US
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Telephone | 480-821-8295
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Fax | 480-821-8268
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH ROBERT MIKULICZ
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Credential | D.M.D.
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Telephone | 480-821-8295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4519
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License Number State | AZ
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