Provider Demographics
NPI:1982704151
Name:MIKITKA, MICHAEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:MIKITKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11892 PROSPECT HILL DR
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8259
Mailing Address - Country:US
Mailing Address - Phone:916-852-8284
Mailing Address - Fax:
Practice Address - Street 1:1675 ALHAMBRA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7047
Practice Address - Country:US
Practice Address - Phone:916-455-3247
Practice Address - Fax:916-455-0439
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA222531223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics