Provider Demographics
NPI:1497848030
Name:MIKULEC, RENEE THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:THI
Last Name:MIKULEC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18745 SHADOW CANYON DR
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-2979
Mailing Address - Country:US
Mailing Address - Phone:161-466-8537
Mailing Address - Fax:614-688-5374
Practice Address - Street 1:999 E BASSE RD STE 116
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1803
Practice Address - Country:US
Practice Address - Phone:210-822-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300222391223P0221X
TX252041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry