Provider Demographics
NPI:1346399730
Name:MIKSZTA, GREGORY J (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:MIKSZTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1968 N PEART RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-421-9939
Mailing Address - Fax:520-421-9929
Practice Address - Street 1:1968 N PEART RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-421-9939
Practice Address - Fax:520-421-9929
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ48721223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics