Provider Demographics
NPI:1619199973
Name:MISISCHIA, WILLIAM W (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:MISISCHIA
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 1:20200 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1671
Mailing Address - Country:US
Mailing Address - Phone:708-755-1333
Mailing Address - Fax:708-755-2751
Practice Address - Street 1:20200 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1671
Practice Address - Country:US
Practice Address - Phone:708-755-1333
Practice Address - Fax:708-755-2751
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0119651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-2746691OtherTAX ID NUMBER