Timothy E Mickiewicz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30810 Issued in CA

Practice address

930 Alhambra Blvd
Ste 110
Sacramento, CA 95816-4479

Phone

(916) 469-9178

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 27, 2026 through Mar 27, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Solano Regional Medical Group, Inc.

  • Family Medicine Physician
  • Fairfield, CA
  • NPI 1528085578
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1346393105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 ALHAMBRA BLVD",
            "address_2": "STE 110",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164479",
            "telephone_number": "916-469-9178",
            "fax_number": "916-246-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 ALHAMBRA BLVD",
            "address_2": "STE 110",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164479",
            "telephone_number": "916-469-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKIEWICZ",
        "first_name": "TIMOTHY",
        "middle_name": "E",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Michel
• Michelle's Miracle Resource Foundation Inc
• Mark A Michelon
• Elizabeth Diane Michelotti, CADCII, CCS
• Chloe Joelle Mick
• Troy Allen Mickle, LMFT
• Sonja Elizabeth Micocci, MFT
• Alice Middleton, BA
• Glenn Alan Middleton, DDS
• Lily Middleton

• General Practice Dentistry in Sacramento, CA
• Providers in Sacramento, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.