Provider Demographics
NPI:1609574615
Name:RONALD N MIZIKOW DDS PC
Entity Type:Organization
Organization Name:RONALD N MIZIKOW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:MIZIKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-941-0010
Mailing Address - Street 1:13727 S HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3628
Mailing Address - Country:US
Mailing Address - Phone:734-941-0010
Mailing Address - Fax:734-941-0010
Practice Address - Street 1:13727 S HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-3628
Practice Address - Country:US
Practice Address - Phone:734-941-0010
Practice Address - Fax:734-941-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental