Provider Demographics
NPI:1962612259
Name:MICHALSKI, STANLEY III
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:MICHALSKI
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1046
Mailing Address - Country:US
Mailing Address - Phone:704-375-8577
Mailing Address - Fax:704-331-9987
Practice Address - Street 1:411 BILLINGSLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1046
Practice Address - Country:US
Practice Address - Phone:704-375-8577
Practice Address - Fax:704-331-9987
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
NC2000010547571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice