Provider Demographics
NPI:1427187897
Name:SPIEWAK, MICHAEL JON (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:SPIEWAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 WYDOWN CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3847
Mailing Address - Country:US
Mailing Address - Phone:608-833-9125
Mailing Address - Fax:
Practice Address - Street 1:3230 UNIVERSITY AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3540
Practice Address - Country:US
Practice Address - Phone:608-231-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice