Provider Demographics
NPI:1205093481
Name:PLISKIN, MICHAEL E (PHD,DDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:PLISKIN
Suffix:
Gender:M
Credentials:PHD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N BROAD ST
Mailing Address - Street 2:TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5007
Mailing Address - Country:US
Mailing Address - Phone:215-707-2913
Mailing Address - Fax:215-707-5885
Practice Address - Street 1:3223 N BROAD ST
Practice Address - Street 2:TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-707-2913
Practice Address - Fax:215-707-5885
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017276L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist