Provider Demographics
NPI:1821988296
Name:MICHAEL CEBULKA DDS, LLC
Entity type:Organization
Organization Name:MICHAEL CEBULKA DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCKBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-475-0425
Mailing Address - Street 1:1090 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1434
Mailing Address - Country:US
Mailing Address - Phone:937-339-5855
Mailing Address - Fax:
Practice Address - Street 1:1090 N MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1434
Practice Address - Country:US
Practice Address - Phone:937-339-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL CEBULKA DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental