Healthcare Provider Details

I. General information

NPI: 1982124863
Provider Name (Legal Business Name): WILLIAM A. MISCHLER DMD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 HIGHWAY 150 STE 1
FLOYDS KNOBS IN
47119-9692
US

IV. Provider business mailing address

3684 HIGHWAY 150 STE 1
FLOYDS KNOBS IN
47119-9692
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-9839
  • Fax:
Mailing address:
  • Phone: 812-923-9839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4963
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12007954A
License Number StateIN

VIII. Authorized Official

Name: DR. WILLIAM A. MISCHLER
Title or Position: OWNER
Credential: DMD
Phone: 812-923-9839