Provider Demographics
NPI:1083711188
Name:MIKULA, JAMES EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MIKULA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15875 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3884
Mailing Address - Country:US
Mailing Address - Phone:734-427-9871
Mailing Address - Fax:734-427-9874
Practice Address - Street 1:15875 MIDDLEBELT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3884
Practice Address - Country:US
Practice Address - Phone:734-427-9871
Practice Address - Fax:734-427-9874
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist