Provider Demographics
NPI:1386783850
Name:INZANA, MICHAEL A (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:INZANA
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 1:146 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-2252
Mailing Address - Country:US
Mailing Address - Phone:814-265-8702
Mailing Address - Fax:
Practice Address - Street 1:51 TAYLOR AVENUE
Practice Address - Street 2:
Practice Address - City:FALLS CREEK
Practice Address - State:PA
Practice Address - Zip Code:15840
Practice Address - Country:US
Practice Address - Phone:814-371-1520
Practice Address - Fax:814-371-1520
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027237L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice