Provider Demographics
NPI:1255482519
Name:MISCH, PAUL JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:MISCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 N MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1608
Mailing Address - Country:US
Mailing Address - Phone:734-522-6470
Mailing Address - Fax:734-522-6937
Practice Address - Street 1:8001 N MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1608
Practice Address - Country:US
Practice Address - Phone:734-522-6470
Practice Address - Fax:734-522-6937
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010109091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice