Provider Demographics
NPI:1376710426
Name:MIKUSKY, CHARLES DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DAVID
Last Name:MIKUSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:23101 SHERMAN PL SUITE 205
Mailing Address - Street 2:CHARLES D MIKUSKY DDS
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2034
Mailing Address - Country:US
Mailing Address - Phone:818-348-5100
Mailing Address - Fax:818-348-5101
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2034
Practice Address - Country:US
Practice Address - Phone:818-348-5100
Practice Address - Fax:818-348-5101
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist