Provider Demographics
NPI:1619051307
Name:MCVICKER, MICHAEL CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:MCVICKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 WOODLEY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1171
Mailing Address - Country:US
Mailing Address - Phone:419-474-5955
Mailing Address - Fax:419-473-3533
Practice Address - Street 1:3829 WOODLEY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1171
Practice Address - Country:US
Practice Address - Phone:419-474-5955
Practice Address - Fax:419-473-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH178621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice