Provider Demographics
NPI:1851443642
Name:MULICK, MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MULICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5395
Mailing Address - Country:US
Mailing Address - Phone:206-325-0166
Mailing Address - Fax:206-726-6039
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:SUITE 330
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5395
Practice Address - Country:US
Practice Address - Phone:206-325-0166
Practice Address - Fax:206-726-6039
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000074491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice