Provider Demographics
NPI:1215320551
Name:MICHAEL D HUMMITZSCH DDS PC
Entity type:Organization
Organization Name:MICHAEL D HUMMITZSCH DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUMMITZSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-772-5362
Mailing Address - Street 1:10665 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5642
Mailing Address - Country:US
Mailing Address - Phone:623-772-5362
Mailing Address - Fax:623-772-6036
Practice Address - Street 1:10665 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE J
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5642
Practice Address - Country:US
Practice Address - Phone:623-772-5362
Practice Address - Fax:623-772-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty