Individual
BRUCE MIKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
380 WASHINGTON AVE, ROOSEVELT, NY 11575-1845
(516) 378-2000
Mailing address
28 BEVERLY RD, FARMINGDALE, NY 11735-3301
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00026016
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00026016
—
NY
Enumeration date
08/01/2006
Last updated
07/08/2007
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