Provider Demographics
NPI:1720455728
Name:GEORGE A MIGHION DDS PC
Entity Type:Organization
Organization Name:GEORGE A MIGHION DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIGHION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-256-1579
Mailing Address - Street 1:3420 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8804
Mailing Address - Country:US
Mailing Address - Phone:574-315-0981
Mailing Address - Fax:
Practice Address - Street 1:3420 HICKORY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8804
Practice Address - Country:US
Practice Address - Phone:574-315-0981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009876261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196930AMedicaid