Provider Demographics
NPI:1093128506
Name:KEVIN P. MISCHLEY, DMD
Entity Type:Organization
Organization Name:KEVIN P. MISCHLEY, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MISCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-668-3970
Mailing Address - Street 1:1329 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1707
Mailing Address - Country:US
Mailing Address - Phone:508-668-3970
Mailing Address - Fax:
Practice Address - Street 1:1329 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1707
Practice Address - Country:US
Practice Address - Phone:508-668-3970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN198421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty