Provider Demographics
NPI:1679785877
Name:GLEN B. MISKA D.D.S., P.C.
Entity Type:Organization
Organization Name:GLEN B. MISKA D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MISKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-365-7531
Mailing Address - Street 1:1953 1ST AVE SE
Mailing Address - Street 2:SUITE D3
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5328
Mailing Address - Country:US
Mailing Address - Phone:319-365-7531
Mailing Address - Fax:319-261-0431
Practice Address - Street 1:1953 1ST AVE SE
Practice Address - Street 2:SUITE D3
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5328
Practice Address - Country:US
Practice Address - Phone:319-365-7531
Practice Address - Fax:319-261-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental