Basic Information
| Provider Information | |||||||||
| NPI: | 1952715906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISCO | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 E. HOSPITAL DRIVE | ||||||||
| Address2: | G1218 TOWSLEY CENTER, SPC 5222 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095222 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 E. HOSPITAL DRIVE | ||||||||
| Address2: | G1218 TOWSLEY CENTER, SPC 5222 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342326048 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 06/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901021311 | MI | Y | Dental Providers | Dentist |
No ID Information.