Provider Demographics
NPI:1760553143
Name:MICHAEL L MIANECKI DDS & JOHN P CARLINO DDS PC
Entity Type:Organization
Organization Name:MICHAEL L MIANECKI DDS & JOHN P CARLINO DDS PC
Other - Org Name:MIANECKI & CARLINO DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOMSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-725-9898
Mailing Address - Street 1:51190 D W SEATON
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047
Mailing Address - Country:US
Mailing Address - Phone:586-725-9898
Mailing Address - Fax:586-725-4470
Practice Address - Street 1:51190 D W SEATON
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047
Practice Address - Country:US
Practice Address - Phone:586-725-9898
Practice Address - Fax:586-725-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12534122300000X
MI16971122300000X
MI17456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1805391Medicaid
MI4125193OtherMEDICAID
MI3331437OtherMEDICAID