Provider Demographics
NPI:1982981692
Name:GRITZUK, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GRITZUK
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 1:1141 MAYBERRY PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-3868
Mailing Address - Country:US
Mailing Address - Phone:026-750-0285
Mailing Address - Fax:
Practice Address - Street 1:8410 S 73RD PLZ STE 106
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-1514
Practice Address - Country:US
Practice Address - Phone:024-592-2219
Practice Address - Fax:531-247-5563
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088871223G0001X
NE72811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice