Provider Demographics
NPI:1407078348
Name:RYCZEK, MICHAEL T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:RYCZEK
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 1:500 MONTAUK HIGHWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-669-2698
Mailing Address - Fax:
Practice Address - Street 1:500 MONTAUK HIGHWAY
Practice Address - Street 2:SUITE D
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-669-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice