Individual
DR. EDWARD JOHN MICKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
113 HOLLAND AVE, ALBANY, NY 12208-3410
(518) 626-6570
Mailing address
26 MORNINGSIDE DR, LATHAM, NY 12110-1302
(518) 786-0940
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
033195
NY
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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