Timothy E Mickiewicz Dental Corporation

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

30810 Issued in CA

Legal business name

TIMOTHY E MICKIEWICZ DENTAL CORPORATION

Practice address

3401 Folsom Blvd
Suite a
Sacramento, CA 95816-5354

Phone

(916) 457-7710

NPI assigned

Feb 16, 2011

Organization subpart

No

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

Authorized official

Name

Timothy Mickiewicz, DDS

Title

Dentist

Phone

(916) 457-7710

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Wilgus, D.D.S.

  • Dentist
  • Sacramento, CA
  • NPI 1861786667
  NPD (past)

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

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407888000000",
    "number": "1558668244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 FOLSOM BLVD",
            "address_2": "SUITE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165354",
            "telephone_number": "916-457-7710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 FOLSOM BLVD",
            "address_2": "SUITE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165354",
            "telephone_number": "916-457-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY E MICKIEWICZ DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-16",
        "last_updated": "2014-08-13",
        "status": "A",
        "authorized_official_last_name": "MICKIEWICZ",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "916-457-7710",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CA",
            "license": "30810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Timmons
• Erica Timms
• Ilona Timofey, ASW
• Avilina Timofeyev
• Igor Timofeyev, MD
• Rose Timothy
• Tina Xiong Gonzalez Licensed Clinical Social Worker PC
• Vanessa Selene Tinajero, LCSW
• Lucinda Lee Tincher, RD
• Brenda Lee Tindal

• Preferred Provider Organization in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Preferred Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.