Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3897 | WV |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 7993 | NC |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 201400263 | NC |
N | 204E00000X | Oral & Maxillofacial Surgeon | 24111 | WV |
N | 208200000X | Surgeon | 2014-00263 | NC |
N | 208600000X | Surgeon | 2014-00263 | NC |
NPI | 1285835355 |
---|---|
Provider Name | Dr. Michael S. Jaskolka |
First Address | Atlanta, GA 31193-6857 |
Second Address | Wilmington, NC 28401-7407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 03/11/2021 |