NPI 1558668244

Timothy E Mickiewicz Dental Corporation

Organisation Preferred Provider Organization Sacramento, CA

Practice location

Address: 3401 Folsom Blvd Suite a, Sacramento, CA 95816-5354
Phone: (916) 457-7710

Authorised official

Name: Timothy Mickiewicz
Title: Dentist
Phone: (916) 457-7710

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 30810 (CA)

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Registry record

NPI: 1558668244
Entity type: Organization
NPI issued: 16 Feb 2011
Record last updated: 13 Aug 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.