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General NPI Number Information
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NPI Number | 1902048754
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Entity Type | Individual
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Provider Name | MICHAEL J MISENCIK DDS
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Gender | Male
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 109 HARRIS ROAD
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City | LODI
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State | OH
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Zip | 44254
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Country | US
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Telephone | 330-302-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 CANYON VIEW RD
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City | SAGAMORE HILLS
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State | OH
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Zip | 44067
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Country | US
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Telephone | 216-688-6349
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 018257
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License Number State | OH
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