Provider Demographics
NPI:1326206970
Name:HISS, MICHAEL GUNTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GUNTER
Last Name:HISS
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 1:12601 WORLD PLAZA LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4064
Mailing Address - Country:US
Mailing Address - Phone:239-437-9446
Mailing Address - Fax:
Practice Address - Street 1:12601 WORLD PLAZA LN
Practice Address - Street 2:SUITE #1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4064
Practice Address - Country:US
Practice Address - Phone:239-437-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024064001223G0001X
PADS031451L1223G0001X
FLDN 20012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice