Provider Demographics
NPI:1306909023
Name:MICHALOWICZ, BRYAN S (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:MICHALOWICZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 COMO AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1460
Mailing Address - Country:US
Mailing Address - Phone:651-647-2500
Mailing Address - Fax:651-632-8984
Practice Address - Street 1:2500 COMO AVENUE
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1460
Practice Address - Country:US
Practice Address - Phone:651-429-2299
Practice Address - Fax:651-429-6630
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics