MEDICARE: DR. MICHAEL MISKELLY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN1858301	MA

General Provider Information

NPI Number	:	1942867544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MISKELLY DMD

Provider Business Mailing Address
First Line	:	22 COLLEGE RD
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-2708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 MAIN ST
Second Line	:
City	:	WEST TOWNSEND
State	:	MA
Zip	:	01474-1052
Country	:	US
Telephone Number	:	978-597-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	09/06/2019

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