Dr Michael S Mecikalski SC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

WI3718 Issued in WI

Legal business name

DR MICHAEL S MECIKALSKI SC

Practice address

310 Parker Street
Boscobel, WI 53805-0188

Phone

(608) 375-4640

NPI assigned

Oct 24, 2006

Reactivated

Aug 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael S Mecikalski, DDS

Title

President

Phone

(608) 375-4640

Specialties & licenses 1

Addresses

Other names 1

• formerly self proprietor 391571294 Other name

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1386727972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "address_2": "310 PARKER STREET",
            "city": "BOSCOBEL",
            "state": "WI",
            "postal_code": "538050188",
            "telephone_number": "608-375-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 PARKER STREET",
            "city": "BOSCOBEL",
            "state": "WI",
            "postal_code": "538050188",
            "telephone_number": "608-375-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MICHAEL S MECIKALSKI SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-08-16",
        "deactivation_date": "2007-07-27",
        "reactivation_date": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "MECIKALSKI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-375-4640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "WI3718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "formerly self proprietor 391571294",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Larry Clark
• Allyson Cooley, PHARMD
• Burton Dale Cox Jr., DO
• Jonathan R Demory
• Barbara L Dewitt
• Carley A Drakas, NP
• Matthew T Drakas, NP
• Ann Drayman, FNP
• Sydney Dressler, DC
• Johnathan Grady Easterling, PHARMD

• General Practice Dentistry in Boscobel, WI
• Providers in Boscobel, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.