Provider Demographics
NPI:1689807901
Name:MISNER, JONATHAN THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THOMAS
Last Name:MISNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1010
Mailing Address - Country:US
Mailing Address - Phone:412-508-1968
Mailing Address - Fax:
Practice Address - Street 1:5130 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1010
Practice Address - Country:US
Practice Address - Phone:412-508-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR4521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery