Provider Demographics
NPI:1528413812
Name:DEREK R. NYKIEL DDS PC
Entity Type:Organization
Organization Name:DEREK R. NYKIEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:R
Authorized Official - Last Name:NYKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:248-642-2115
Mailing Address - Street 1:31100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4363
Mailing Address - Country:US
Mailing Address - Phone:248-642-2115
Mailing Address - Fax:248-642-6387
Practice Address - Street 1:31100 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4363
Practice Address - Country:US
Practice Address - Phone:248-642-2115
Practice Address - Fax:248-642-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIFN4192580OtherDEA