Provider Demographics
NPI:1861540122
Name:KAMINSKI, MICHAEL JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:KAMINSKI
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 1:17902 GEORGIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2272
Mailing Address - Country:US
Mailing Address - Phone:301-774-3800
Mailing Address - Fax:301-570-7027
Practice Address - Street 1:17902 GEORGIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2272
Practice Address - Country:US
Practice Address - Phone:301-774-3800
Practice Address - Fax:301-570-7027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice