Provider Demographics
NPI:1184633380
Name:MIGDALSKI, MARK ZYGMUNT (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ZYGMUNT
Last Name:MIGDALSKI
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 1:465 ST. MICHAEL'S DR.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-9060
Mailing Address - Country:US
Mailing Address - Phone:505-820-1010
Mailing Address - Fax:505-820-7639
Practice Address - Street 1:465 ST. MICHAEL'S DR.
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-9060
Practice Address - Country:US
Practice Address - Phone:505-820-1010
Practice Address - Fax:505-820-7639
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist