Provider Demographics
NPI:1801012497
Name:MISCH, NORBERT LEO JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:NORBERT
Middle Name:LEO
Last Name:MISCH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E OAK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4575
Mailing Address - Country:US
Mailing Address - Phone:407-847-8000
Mailing Address - Fax:407-847-6773
Practice Address - Street 1:701 E OAK ST
Practice Address - Street 2:SUITE B
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4575
Practice Address - Country:US
Practice Address - Phone:407-847-8000
Practice Address - Fax:407-847-6773
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN135381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice