Organization
MIKULENCAK ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MATTHEW MIKULENCAK DDS, MS (PRESIDENT)
(817) 923-5400
Entity
Organization
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
11/13/2007
Last updated
04/07/2008
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