Provider Demographics
NPI:1477676591
Name:MUSHNICK, MICHAEL A (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MUSHNICK
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 1:100 OVERLOOK DR
Mailing Address - Street 2:THE PNDVIEW PLAZA
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5500
Mailing Address - Country:US
Mailing Address - Phone:609-655-8660
Mailing Address - Fax:609-655-8699
Practice Address - Street 1:100 OVERLOOK DR
Practice Address - Street 2:THE PNDVIEW PLAZA
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5500
Practice Address - Country:US
Practice Address - Phone:609-655-8660
Practice Address - Fax:609-655-8699
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015771001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice