Provider Demographics
NPI:1942588397
Name:MISISCHIA, WILLIAM PATRICK (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:MISISCHIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-3396
Mailing Address - Country:US
Mailing Address - Phone:034-490-4103
Mailing Address - Fax:303-449-0470
Practice Address - Street 1:350 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3396
Practice Address - Country:US
Practice Address - Phone:034-490-4103
Practice Address - Fax:303-449-0470
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics