Individual
MARITZA ANDREINA MICHALAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3575 PORTAGE RD STE A, SOUTH BEND, IN 46628-6092
(574) 349-2073
Mailing address
705 N HILL ST, SOUTH BEND, IN 46617-1912
(813) 990-7449
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013318A
IN
1223G0001X
General Practice Dentistry
22927
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/19/2017
Last updated
10/16/2024
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