Provider Demographics
NPI:1063555043
Name:MIERZEJEWSKI, MICHAEL JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MIERZEJEWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 FEDERAL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-8615
Mailing Address - Country:US
Mailing Address - Phone:303-427-2722
Mailing Address - Fax:303-427-9280
Practice Address - Street 1:10350 FEDERAL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-8615
Practice Address - Country:US
Practice Address - Phone:303-427-2722
Practice Address - Fax:303-427-9280
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV51331223G0001X, 122300000X
CO10703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice