Healthcare Provider Details

I. General information

NPI: 1598843633
Provider Name (Legal Business Name): DR. DONALD M MISSIRLIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUTTER ST 405
SAN FRANCISCO CA
94102-1107
US

IV. Provider business mailing address

500 SUTTER ST 405
SAN FRANCISCO CA
94102-1107
US

V. Phone/Fax

Practice location:
  • Phone: 415-399-9595
  • Fax: 415-399-9598
Mailing address:
  • Phone: 415-399-9595
  • Fax: 415-399-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number18592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: