Provider Demographics
NPI:1881010007
Name:TUNICK, MICHAEL (DDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TUNICK
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 1:4030 SHERIDAN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3536
Mailing Address - Country:US
Mailing Address - Phone:954-966-6410
Mailing Address - Fax:954-966-2094
Practice Address - Street 1:4030 SHERIDAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3536
Practice Address - Country:US
Practice Address - Phone:954-966-6410
Practice Address - Fax:954-966-2094
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN41851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice