Provider Demographics
NPI:1437223419
Name:MICHALIK, THOMAS STANLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STANLEY
Last Name:MICHALIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9094 E. MINERAL AVE.
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-768-8570
Mailing Address - Fax:303-768-8572
Practice Address - Street 1:9094 E. MINERAL AVE.
Practice Address - Street 2:SUITE 260
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-768-8570
Practice Address - Fax:303-768-8572
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO391071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07436238Medicaid