Provider Demographics
NPI:1356668248
Name:PINK, MICHAEL THOMAS (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:PINK
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MACOM DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-3202
Mailing Address - Country:US
Mailing Address - Phone:630-851-9100
Mailing Address - Fax:630-851-6983
Practice Address - Street 1:1303 MACOM DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-3202
Practice Address - Country:US
Practice Address - Phone:630-851-9100
Practice Address - Fax:630-851-6983
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0378201223S0112X
IL0190264651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery