Individual
MICHAEL MALIVUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5780 N CAREFREE CIR, COLORADO SPRINGS, CO 80917-2795
(719) 597-9737
Mailing address
5780 N. CAREFREE CIRCLE, COLORADO SPRINGS, CO 80917
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7155
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7155
DENTAL LICENSE
CO
Enumeration date
04/27/2007
Last updated
07/08/2007
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