Provider Demographics
NPI:1699782524
Name:MICHANOWICZ, ANDREW M (DMD MDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:MICHANOWICZ
Suffix:
Gender:M
Credentials:DMD MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 PENN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648
Mailing Address - Country:US
Mailing Address - Phone:814-696-1800
Mailing Address - Fax:814-696-5950
Practice Address - Street 1:920 PENN STREET
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648
Practice Address - Country:US
Practice Address - Phone:814-696-1800
Practice Address - Fax:814-696-1800
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024940L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics