Provider Demographics
NPI:1245794346
Name:CYNTHIA J MIKULA DDS INC
Entity Type:Organization
Organization Name:CYNTHIA J MIKULA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-871-7170
Mailing Address - Street 1:572 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2361
Mailing Address - Country:US
Mailing Address - Phone:440-871-7170
Mailing Address - Fax:440-899-6375
Practice Address - Street 1:572 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2361
Practice Address - Country:US
Practice Address - Phone:440-871-7170
Practice Address - Fax:440-899-6375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CYNTHIA J MIKULA DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies