Provider Demographics
NPI: | 1972220762 |
---|---|
Name: | CAMILLA L MISKOVICH DMD PLLC |
Entity Type: | Organization |
Organization Name: | CAMILLA L MISKOVICH DMD PLLC |
Other - Org Name: | BIG LITTLE SMILES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CAMILLA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | MISKOVICH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 980-285-7792 |
Mailing Address - Street 1: | 1730 MATTHEWS TOWNSHIP PKWY STE D |
Mailing Address - Street 2: | |
Mailing Address - City: | MATTHEWS |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28105-4928 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-703-7232 |
Mailing Address - Fax: | 704-703-2327 |
Practice Address - Street 1: | 1730 MATTHEWS TOWNSHIP PKWY STE D |
Practice Address - Street 2: | |
Practice Address - City: | MATTHEWS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28105-4928 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-703-7232 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-10-24 |
Last Update Date: | 2023-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Single Specialty |