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General NPI Number Information
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NPI Number | 1912997735
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Entity Type | Individual
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Provider Name | MARK A. MIKUS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 9400 MCKNIGHT RD STE 101
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City | PITTSBURGH
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State | PA
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Zip | 15237-6007
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Country | US
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Telephone | 412-369-7122
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Fax | 412-369-7433
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Provider Business Mailing Address
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Address Line | 505 CREEKSIDE CT
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-3371
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Country | US
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Telephone | 724-772-3209
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Fax | 412-369-7433
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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 | DS031540L
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License Number State | PA
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