Provider Demographics
NPI:1285608141
Name:MISIEK, DALE JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:JOSEPH
Last Name:MISIEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WATERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-7210
Mailing Address - Country:US
Mailing Address - Phone:985-789-5808
Mailing Address - Fax:
Practice Address - Street 1:1225 WATERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-7210
Practice Address - Country:US
Practice Address - Phone:985-789-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68471223S0112X
LA33611223S0112X
TN121331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9002HOtherBCBS
NC799002HMedicaid
LA1833614Medicaid
NCTI9805Medicare UPIN