Individual
RICHARD MICHALOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
40 HOLLAND ST, SOMERVILLE, MA 02144-2705
(617) 629-6080
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18428
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PD212
HARVARD PILGRIM
MA
01
—
X07997
BCBS DENTAL
MA
Enumeration date
03/20/2006
Last updated
07/21/2022
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