Provider Demographics
NPI:1467616417
Name:MIKULA, AMY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:MIKULA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4430
Mailing Address - Country:US
Mailing Address - Phone:410-267-9311
Mailing Address - Fax:
Practice Address - Street 1:1831 FOREST DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MARYLAND
Practice Address - Zip Code:21401
Practice Address - Country:UM
Practice Address - Phone:410-267-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice