Provider Demographics
NPI:1952605461
Name:JOSEPH A MIKA DDS LLC
Entity Type:Organization
Organization Name:JOSEPH A MIKA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-778-1242
Mailing Address - Street 1:5815 MARKET ST #6
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:800-778-1242
Mailing Address - Fax:
Practice Address - Street 1:5815 MARKET ST STE 6
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2915
Practice Address - Country:US
Practice Address - Phone:800-778-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty