Healthcare Provider Details

I. General information

NPI: 1285608141
Provider Name (Legal Business Name): DALE JOSEPH MISIEK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WATERSTONE BLVD
FRANKLIN TN
37069-7210
US

IV. Provider business mailing address

1225 WATERSTONE BLVD
FRANKLIN TN
37069-7210
US

V. Phone/Fax

Practice location:
  • Phone: 985-789-5808
  • Fax:
Mailing address:
  • Phone: 985-789-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6847
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3361
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12133
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: