Provider Demographics
NPI:1477996718
Name:MAJCHROWICZ, MICHAEL ALBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALBERT
Last Name:MAJCHROWICZ
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 1:2121 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5100
Mailing Address - Country:US
Mailing Address - Phone:260-460-1353
Mailing Address - Fax:260-460-1308
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-460-1353
Practice Address - Fax:260-460-1308
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDENT778122300000X
AKAA - 778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist