Provider Demographics
NPI:1912064981
Name:DINCAU, MICHAEL DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DONALD
Last Name:DINCAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:D
Other - Last Name:DINCAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:1237 E PARKDALE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660
Mailing Address - Country:US
Mailing Address - Phone:231-723-1178
Mailing Address - Fax:231-723-6399
Practice Address - Street 1:1237 E PARKDALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660
Practice Address - Country:US
Practice Address - Phone:231-723-1178
Practice Address - Fax:231-723-6399
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist