Provider Demographics
NPI:1427252204
Name:MISHLER, COLLEEN G (DMD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:G
Last Name:MISHLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:G
Other - Last Name:TUMADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7410 BOYNTON BEACH BLVD
Mailing Address - Street 2:STE B3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6158
Mailing Address - Country:US
Mailing Address - Phone:561-734-7171
Mailing Address - Fax:561-734-8884
Practice Address - Street 1:3911 WEST ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-498-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice