Healthcare Provider Details

I. General information

NPI: 1861692360
Provider Name (Legal Business Name): DAVID H MISHLER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N 400 W
LINDON UT
84042-1817
US

IV. Provider business mailing address

165 N 400 W
LINDON UT
84042-1817
US

V. Phone/Fax

Practice location:
  • Phone: 415-264-3409
  • Fax:
Mailing address:
  • Phone: 415-264-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4947499-9923
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1243
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: