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Michael L Iczkovitz, DDS
Oral and Maxillofacial Surgery (Dentist) in Fort Wayne, Indiana
NPI 1235159930

Michael L Iczkovitz is a Oral and Maxillofacial Surgery (Dentist) based in Fort Wayne, IN and is specialized in Oral and Maxillofacial Surgery. Michael L Iczkovitz practices in Fort Wayne, IN and has the professional credentials of DDS. The NPI Number for Michael L Iczkovitz is 1235159930 and holds a License No. 12008664 (Indiana).

The current practice location address for Michael L Iczkovitz is 3303 Trier Rd, Fort Wayne, IN and can be reached out via phone at 260-484-9990 and via fax at 260-484-6573.

Location: 3303 Trier Rd, Fort Wayne, IN, 46815-4768
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1235159930
Provider Name
Michael L Iczkovitz
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
3303 Trier Rd, Fort Wayne, IN, 46815-4768
Phone Number
260-484-9990
Fax Number
260-484-6573
Provider Enumeration Date
07/19/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100079980 05 IN
000000086698 01 IN BCBS/ANTHEM
institution
Provider Business Practice Location Address Details
Address
3303 Trier Rd
City
Fort Wayne
State
Indiana
Zip
46815-4768
Phone Number
260-484-9990
Fax Number
260-484-6573
person
Provider Business Mailing Address Details
Address
3303 Trier Rd
City
Fort Wayne
State
Indiana
Zip
46815-4768
Phone Number
260-484-9990
Fax Number
260-484-6573
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
12008664 (Indiana)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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