Provider Demographics
NPI:1568975126
Name:TULAK-GORECKI, MICHELE M (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:TULAK-GORECKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MARLOW DR.
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2175
Mailing Address - Country:US
Mailing Address - Phone:586-751-7777
Mailing Address - Fax:586-751-5845
Practice Address - Street 1:1905 MARLOW DR.
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2175
Practice Address - Country:US
Practice Address - Phone:586-751-7777
Practice Address - Fax:586-751-5845
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist