Individual
MICHAEL TADAYUKI MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(808) 351-5148
Mailing address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
DT-3153
HI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/29/2020
Last updated
05/28/2024
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