Mikulencak Orthodontics

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

20876 Issued in TX

Legal business name

MIKULENCAK ORTHODONTICS

Practice address

4544 Hartwood Dr
Fort Worth, TX 76109-1840

Phone

(817) 923-5400

NPI assigned

Nov 13, 2007

Last updated

Apr 7, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Matthew Mikulencak, DDS, MSNPI 1548453335

Title

President

Phone

(817) 923-5400

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Matthew Mikulencak, DDS, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fort Worth, TX
  • NPI 1548453335
  NPD (past) Authorized official

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1912187428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 TANGLEWOOD TRL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761092014",
            "telephone_number": "817-584-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4544 HARTWOOD DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761091840",
            "telephone_number": "817-923-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKULENCAK ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "MIKULENCAK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-923-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "20876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Diane Mijares, AGNP
• Adriana Mikals
• Jack L Mikeworth, D.C.
• David Mikitka, D.D.S.
• Mikkelsen, LLC
• David Matthew Mikulencak, DDS, MS
• Mila Family Health
• Lisa Marie Miladinovich, PTA
• Mary Milam, MD
• Rachelle Milam, RN

• Orthodontics and Dentofacial Orthopedics Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; 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.