Provider Demographics
NPI:1508313198
Name:MICHAEL R DOROCIAK DDS PA
Entity Type:Organization
Organization Name:MICHAEL R DOROCIAK DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-924-1100
Mailing Address - Street 1:3900 CLARK RD
Mailing Address - Street 2:STE J5
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2367
Mailing Address - Country:US
Mailing Address - Phone:941-924-1100
Mailing Address - Fax:941-924-6527
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:STE J5
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2367
Practice Address - Country:US
Practice Address - Phone:941-924-1100
Practice Address - Fax:941-924-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN110601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty