Provider Demographics
NPI:1548486376
Name:MICHALAK, CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MICHALAK
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 1:3448 NAVARRE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3448
Mailing Address - Country:US
Mailing Address - Phone:419-693-0569
Mailing Address - Fax:419-693-0165
Practice Address - Street 1:3448 NAVARRE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3448
Practice Address - Country:US
Practice Address - Phone:419-693-0569
Practice Address - Fax:419-693-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH169461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice