Provider Demographics
NPI:1679100432
Name:MISCHO, SARAH ELIZABETH (DMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:MISCHO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WUNDERLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:282 VALLEY STREAM RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2874
Mailing Address - Country:US
Mailing Address - Phone:920-915-9912
Mailing Address - Fax:
Practice Address - Street 1:103 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3193
Practice Address - Country:US
Practice Address - Phone:910-497-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC12200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program