Organization
CENTRAL OREGON PERIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS W MISISCHIA DMD (PRESIDENT)
(541) 317-0255
Entity
Organization
Contact information
Practice address
1569 SW NANCY WAY STE 3, BEND, OR 97702
(541) 317-0255
(541) 317-0355
Mailing address
1569 SW NANCY WAY, BEND, OR 97702-3234
(541) 317-0255
(541) 317-0355
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D7709
OR
Other
Enumeration date
11/28/2006
Last updated
07/09/2010
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