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General NPI Number Information
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NPI Number | 1245785070
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Entity Type | Organization
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Legal Business Name | MISNER DENTAL GROUP INC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 6361 PACIFIC BLVD # 100
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4101
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Country | US
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Telephone | 323-694-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 E BIJOU ST STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-8009
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Country | US
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Telephone | 719-323-2362
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Fax | 719-410-0723
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Authorized Official
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Title or Position | OWNER
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Name | DR. REBECCA MISNER
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Credential | DMD
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Telephone | 719-323-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | CA
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