Individual
MICHELLE LYNNE MISTELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
3533 DREHER SHOALS RD, IRMO, SC 29063-9115
(803) 732-3001
(803) 732-3190
Mailing address
1315 GLENN ST, NEWBERRY, SC 29108-3015
(803) 276-1329
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
003337
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9727
—
SC
Enumeration date
02/07/2007
Last updated
07/09/2007
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