Provider Demographics
NPI:1962575522
Name:MICHALKA, WAYNE A (DMD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:MICHALKA
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 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-372-3726
Mailing Address - Fax:203-374-1452
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-372-3726
Practice Address - Fax:203-374-1452
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT82311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice