Healthcare Provider Details

I. General information

NPI: 1679785877
Provider Name (Legal Business Name): GLEN B. MISKA D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 1ST AVE SE SUITE D3
CEDAR RAPIDS IA
52402-5328
US

IV. Provider business mailing address

1953 1ST AVE SE SUITE D3
CEDAR RAPIDS IA
52402-5328
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-7531
  • Fax: 319-261-0431
Mailing address:
  • Phone: 319-365-7531
  • Fax: 319-261-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLEN B MISKA
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 319-365-7531