Healthcare Provider Details

I. General information

NPI: 1881700680
Provider Name (Legal Business Name): WILLIAM ALAN MISCHLER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 SOUTHERN PKWY 2D
LOUISVILLE KY
40214-1442
US

IV. Provider business mailing address

4602 SOUTHERN PKWY 2D
LOUISVILLE KY
40214-1442
US

V. Phone/Fax

Practice location:
  • Phone: 502-368-2513
  • Fax:
Mailing address:
  • Phone: 502-368-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4963
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: