Provider Demographics
NPI:1245372556
Name:MISCHUK, PHILIP GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GREGORY
Last Name:MISCHUK
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 1:39150 DEQUINDRE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6989
Mailing Address - Country:US
Mailing Address - Phone:586-979-7333
Mailing Address - Fax:
Practice Address - Street 1:39150 DEQUINDRE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6989
Practice Address - Country:US
Practice Address - Phone:586-979-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist