Provider Demographics
NPI:1487749701
Name:MIESEL, TODD V (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:V
Last Name:MIESEL
Suffix:
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 1:405 N DAVIES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9450
Mailing Address - Country:US
Mailing Address - Phone:425-397-8672
Mailing Address - Fax:
Practice Address - Street 1:10515 20TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98205-2035
Practice Address - Country:US
Practice Address - Phone:425-334-9600
Practice Address - Fax:425-334-9900
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA79811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice