Provider Demographics
NPI:1669817441
Name:MIKER, TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:MIKER
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 1:7057 W 130TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7893
Mailing Address - Country:US
Mailing Address - Phone:440-887-1121
Mailing Address - Fax:
Practice Address - Street 1:7057 W 130TH ST STE 302
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7893
Practice Address - Country:US
Practice Address - Phone:440-887-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OH30.023937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies