Provider Demographics
NPI:1821166356
Name:MIKULIC, STEPHEN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALLEN
Last Name:MIKULIC
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 1:581 FOSTER CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:650-286-9999
Mailing Address - Fax:650-286-9986
Practice Address - Street 1:581 FOSTER CITY BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:650-286-9999
Practice Address - Fax:650-286-9986
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist