Provider Demographics
NPI:1992879118
Name:SUSAN M MISCHISSIN DMD PC
Entity type:Organization
Organization Name:SUSAN M MISCHISSIN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MISCHISSIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:609-465-4411
Mailing Address - Street 1:900 ROUTE 9 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210
Mailing Address - Country:US
Mailing Address - Phone:609-465-4411
Mailing Address - Fax:609-465-4503
Practice Address - Street 1:900 ROUTE 9 SOUTH
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:609-465-4411
Practice Address - Fax:609-465-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0178441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty