Provider Demographics
NPI:1386727972
Name:DR MICHAEL S MECIKALSKI SC
Entity type:Organization
Organization Name:DR MICHAEL S MECIKALSKI SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MECIKALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-375-4640
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:310 PARKER STREET
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-0188
Mailing Address - Country:US
Mailing Address - Phone:608-375-4640
Mailing Address - Fax:
Practice Address - Street 1:310 PARKER STREET
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-0188
Practice Address - Country:US
Practice Address - Phone:608-375-4640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-08-16
Deactivation Date:2007-07-27
Deactivation Code:
Reactivation Date:2007-08-16
Provider Licenses
StateLicense IDTaxonomies
WIWI37181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty