Provider Demographics
NPI:1346930633
Name:MICHAEL T. NYKAMP, DDS FAMILY & COSMETIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:MICHAEL T. NYKAMP, DDS FAMILY & COSMETIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NYKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-321-4254
Mailing Address - Street 1:5123 W ST JOE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4028
Mailing Address - Country:US
Mailing Address - Phone:517-321-4254
Mailing Address - Fax:517-321-0729
Practice Address - Street 1:5123 W ST JOE HWY STE 101
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4028
Practice Address - Country:US
Practice Address - Phone:517-321-4254
Practice Address - Fax:517-321-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental