Provider Demographics
NPI:1932644234
Name:MISHLER DENTAL LLC
Entity Type:Organization
Organization Name:MISHLER DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MISHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-362-1906
Mailing Address - Street 1:380 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1632
Mailing Address - Country:US
Mailing Address - Phone:765-362-1906
Mailing Address - Fax:
Practice Address - Street 1:380 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1632
Practice Address - Country:US
Practice Address - Phone:765-362-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012292A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty