Provider Demographics
NPI:1134117617
Name:NTUK, MICHAEL (DDS, MPH, FAGD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:NTUK
Suffix:
Gender:M
Credentials:DDS, MPH, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 BRANCH AVE
Mailing Address - Street 2:405
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1242
Mailing Address - Country:US
Mailing Address - Phone:301-899-0871
Mailing Address - Fax:301-702-2688
Practice Address - Street 1:3611 BRANCH AVE
Practice Address - Street 2:405
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1242
Practice Address - Country:US
Practice Address - Phone:301-899-0871
Practice Address - Fax:301-702-2688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice