Provider Demographics
NPI:1598843633
Name:MISSIRLIAN, DONALD M
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:MISSIRLIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUTTER ST
Mailing Address - Street 2:405
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1107
Mailing Address - Country:US
Mailing Address - Phone:415-399-9595
Mailing Address - Fax:415-399-9598
Practice Address - Street 1:500 SUTTER ST
Practice Address - Street 2:405
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1107
Practice Address - Country:US
Practice Address - Phone:415-399-9595
Practice Address - Fax:415-399-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics