Provider Demographics
NPI:1679634166
Name:MISKOFSKI, CATHERINE PATRICIA
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PATRICIA
Last Name:MISKOFSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:PATRICIA
Other - Last Name:RENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:70091 COBB RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2405
Mailing Address - Country:US
Mailing Address - Phone:319-572-7747
Mailing Address - Fax:
Practice Address - Street 1:285 S PALM CANYON DR STE D7
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6360
Practice Address - Country:US
Practice Address - Phone:760-320-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice