MEDICARE: DR. MICHAEL NTUK DDS, MPH, FAGD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11826	MD

General Provider Information

NPI Number	:	1134117617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL NTUK DDS, MPH, FAGD

Provider Business Mailing Address
First Line	:	3611 BRANCH AVE
Second Line	:	405
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1242
Country	:	US
Telephone Number	:	301-899-0871
Fax Number	:	301-702-2688

Provider Business Practice Location Address
First Line	:	3611 BRANCH AVE
Second Line	:	405
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1242
Country	:	US
Telephone Number	:	301-899-0871
Fax Number	:	301-702-2688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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