Provider Demographics
NPI:1740360593
Name:BABICS, MICHAEL DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:BABICS
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 1:1515 PORTAGE ST NW
Mailing Address - Street 2:SUITE H
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2290
Mailing Address - Country:US
Mailing Address - Phone:330-494-8508
Mailing Address - Fax:330-494-8580
Practice Address - Street 1:1515 PORTAGE ST NW
Practice Address - Street 2:SUITE H
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2290
Practice Address - Country:US
Practice Address - Phone:330-494-8508
Practice Address - Fax:330-494-8580
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0149171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice