Provider Demographics
NPI:1174965339
Name:VILAG, MICHAEL JOHN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:VILAG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24201 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-2134
Mailing Address - Country:US
Mailing Address - Phone:734-692-0102
Mailing Address - Fax:734-692-1541
Practice Address - Street 1:24201 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2134
Practice Address - Country:US
Practice Address - Phone:734-692-0102
Practice Address - Fax:734-692-1541
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist