Provider Demographics
NPI:1326415753
Name:RISSLER, MISOOK AN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MISOOK
Middle Name:AN
Last Name:RISSLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MISOOK
Other - Middle Name:NMN
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1722 S GLENSTONE AVE STE O&P
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1513
Mailing Address - Country:US
Mailing Address - Phone:417-248-1234
Mailing Address - Fax:172-481-5154
Practice Address - Street 1:14303 W. STATE HWY 38
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706
Practice Address - Country:US
Practice Address - Phone:417-859-0711
Practice Address - Fax:417-859-0718
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015021497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist