Provider Demographics
NPI:1821027152
Name:PODLUSKY, MICHAEL ANTHONY (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:PODLUSKY
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 SEMINOLE BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33778-4210
Mailing Address - Country:US
Mailing Address - Phone:727-393-8912
Mailing Address - Fax:727-393-7735
Practice Address - Street 1:10333 SEMINOLE BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33778-4210
Practice Address - Country:US
Practice Address - Phone:727-393-8912
Practice Address - Fax:727-393-7735
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 10371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist