Provider Demographics
NPI:1366792657
Name:MISHKO, RONALD II (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MISHKO
Suffix:II
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 1:2211 S TELEGRAPH RD UNIT 7048
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-4801
Mailing Address - Country:US
Mailing Address - Phone:248-431-4700
Mailing Address - Fax:248-738-9026
Practice Address - Street 1:1264 S COMMERCE RD
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3008
Practice Address - Country:US
Practice Address - Phone:248-431-4700
Practice Address - Fax:248-738-9026
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice