Mike'S Dental Lab

Primary specialty

Dental LaboratoryTaxonomy code 292200000X

License

347527 Issued in CA

Legal business name

MIKE'S DENTAL LAB

Practice address

1735 Professional Drive
Sacramento, CA 95825

Phone

(916) 487-2236

NPI assigned

Feb 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael J Tetrick, CDT

Title

Certified Dental Technician

Phone

(916) 487-2236

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1134493943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 PROFESSIONAL DRIVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95825",
            "telephone_number": "916-487-2236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 PROFESSIONAL DRIVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95825",
            "telephone_number": "916-487-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKE'S DENTAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "TETRICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CERTIFIED DENTAL TECHNICIAN",
        "authorized_official_telephone_number": "916-487-2236",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CDT"
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "CA",
            "license": "347527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Ann Mikacich, MD
• Joyce M Mikal-Flynn, NP
• Traci Mikasa, DO
• Mike T Martinez
• Omar Mike
• Sherri Monique Mikel
• Noor Faris Mikha
• Tatyana Mikitiuk, RN
• Michael A. Mikitka, D.D.S.
• Angelina Mikityuk

• Dental Laboratory in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Dental Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.