Provider Demographics
NPI:1134344963
Name:PAWLUS, MICHAEL ADAM (DDS MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:PAWLUS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 STICKNEY PT RD
Mailing Address - Street 2:#100A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-923-2288
Mailing Address - Fax:941-922-0562
Practice Address - Street 1:2477 STICKNEY PT RD
Practice Address - Street 2:#100A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231
Practice Address - Country:US
Practice Address - Phone:941-923-2288
Practice Address - Fax:941-922-0562
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics