Provider Demographics
NPI:1710581277
Name:JONATHAN MIODOWNIK DMD PLLC
Entity type:Organization
Organization Name:JONATHAN MIODOWNIK DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIODOWNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-557-2618
Mailing Address - Street 1:24764 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2715
Mailing Address - Country:US
Mailing Address - Phone:248-557-2618
Mailing Address - Fax:
Practice Address - Street 1:24764 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2715
Practice Address - Country:US
Practice Address - Phone:248-557-2618
Practice Address - Fax:248-557-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty