Provider Demographics
NPI:1124187398
Name:UZELAC, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:UZELAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:UZELAC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:850 MARSH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385
Mailing Address - Country:US
Mailing Address - Phone:219-464-8532
Mailing Address - Fax:219-548-8842
Practice Address - Street 1:850 MARSH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:219-464-8532
Practice Address - Fax:219-548-8842
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist