Provider Demographics
NPI:1124746227
Name:MISHKO DENTAL PC
Entity type:Organization
Organization Name:MISHKO DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-734-2828
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-0215
Mailing Address - Country:US
Mailing Address - Phone:989-734-2828
Mailing Address - Fax:
Practice Address - Street 1:216 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1712
Practice Address - Country:US
Practice Address - Phone:989-734-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty