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General NPI Number Information
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NPI Number | 1215249685
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Entity Type | Individual
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Provider Name | NICHOLAS W. MISISCHIA DMD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 1569 SW NANCY WAY LOWER LEVEL
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City | BEND
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State | OR
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Zip | 97702-3234
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Country | US
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Telephone | 541-317-0255
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Fax | 541-317-0355
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Provider Business Mailing Address
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Address Line | 1569 SW NANCY WAY LOWER LEVEL
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City | BEND
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State | OR
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Zip | 97702-3234
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Country | US
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Telephone | 541-317-0255
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Fax | 541-317-0355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D7709
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License Number State | OR
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