Provider Demographics
NPI:1013089978
Name:MISLEH, ANTON FUAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:FUAD
Last Name:MISLEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 GENESEE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4900
Mailing Address - Country:US
Mailing Address - Phone:958-268-1618
Mailing Address - Fax:858-874-0333
Practice Address - Street 1:4320 GENESEE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4900
Practice Address - Country:US
Practice Address - Phone:958-268-1618
Practice Address - Fax:858-874-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist