Provider Demographics
NPI:1982124863
Name:WILLIAM A. MISCHLER DMD PSC
Entity Type:Organization
Organization Name:WILLIAM A. MISCHLER DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MISCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-923-9839
Mailing Address - Street 1:3684 HIGHWAY 150 STE 1
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9692
Mailing Address - Country:US
Mailing Address - Phone:812-923-9839
Mailing Address - Fax:
Practice Address - Street 1:3684 HIGHWAY 150 STE 1
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9692
Practice Address - Country:US
Practice Address - Phone:812-923-9839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007954A1223X0400X
KY49631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60049632Medicaid
IN201409950AMedicaid