Provider Demographics
NPI:1528278918
Name:MARCINCUK, MICHAEL JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MARCINCUK
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 1:412 E DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-1425
Mailing Address - Country:US
Mailing Address - Phone:269-469-1358
Mailing Address - Fax:269-465-3001
Practice Address - Street 1:RED ARROW DENTISTRY
Practice Address - Street 2:9500 RED ARROW HIGHWAY
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106
Practice Address - Country:US
Practice Address - Phone:269-465-3001
Practice Address - Fax:269-465-3001
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist