Provider Demographics
NPI:1700442746
Name:MISSIH DENTAL CARE & PERIODONTICS LLC
Entity Type:Organization
Organization Name:MISSIH DENTAL CARE & PERIODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:COMLAN
Authorized Official - Middle Name:MARCEL
Authorized Official - Last Name:MISSIH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH, MA
Authorized Official - Phone:607-798-7188
Mailing Address - Street 1:355 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-798-7188
Mailing Address - Fax:607-797-8435
Practice Address - Street 1:355 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-798-7188
Practice Address - Fax:607-797-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental