Individual
DAVID MATTHEW MIKULENCAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
4544 HARTWOOD DR, FORT WORTH, TX 76109-1840
(817) 923-5400
Mailing address
3208 TANGLEWOOD TRL, FORT WORTH, TX 76109-2014
(817) 584-0135
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
20876
TX
Other
Enumeration date
08/24/2007
Last updated
04/07/2008
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