Basic Information
| Provider Information | |||||||||
| NPI: | 1952605461 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSEPH A MIKA DDS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5815 MARKET ST #6 | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007781242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5815 MARKET ST STE 6 | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445122915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007781242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2010 | ||||||||
| LastUpdateDate: | 12/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | MIKA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8007781242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.